1) Age (Years):

2) Sex: Male Female

3) Weight:

4) Height:

5) Which option best describes your body frame? Small Medium Large

6) What is your occupation?

7) How often do you drink? Everyday A Few Times a Week A Few Times a Month A Few Times a Year Never

8) What is your average weekly alcohol consumption? (Please state type and quantity)
Type: Quantity:

9) Where do you regularly drink? (Select those which are most appropriate):
At Home At Pub At a Club At Friends Other Don't Drink

10) Type of driving licence held: None Provisional Full HGV

11) What quantity of alcohol do you think you could drink between 8:00pm and 10:00pm and still feel capable of safely driving home at 11:00pm? Pints OR Shots

12) What quantity of alcohol do you think you could drink between 8:00pm and 10:00pm and still feel under the legal limit at 11:00pm? Pints OR Shots

13) Which statement best fits your thoughts on the current 'Drink Drive' Laws? Too Lenient About Right Too Restrictive Never Thought About It

14) Do you know the current legal blood alcohol limit? Yes No
If yes please specify:

15) Do you regularly take medication? Yes No
If yes, please specify name of medication:

16) Where would you find out information regarding your medication and driving? Packet / Bottle Your Doctor The Pharmacist Don't Know