Ok so here are the actual questions as I screenshot them 1) As a result of your alcohol dependence have you needed to take prescribed medication to help you stop drinking 2) When did you last have a alcoholic drink, how many units 3) How often do you have a drink with alcohol in it 4) Within the last six years have you been dependent on or regularly misused alcohol 5) Within the last six years have you had an accident/injury or a road traffic accident as a result of your alcohol intake 6) Within the last six years have you had a problem with your home/family work as a result of your alcohol intake 7) Within the last six years have you been told you have liver damage 8) Within the last six years have you required treatment for a alcohol related illness 9) Have you had any fits blackouts seizures in the last five years 10) Within the last three years have you misused any drugs including prescribed over the counter medication or any other substance 11) Have you had any mental health problems in the last three years.All these questions are to tick a box and if you do to to give dates, you then sign a declaration and give your doctors name address etc, after that there is another medical questionnaire all about drinking with multiple choice i.e. How many drinks do you have in one day ,do you have a drink first thing in the morning, how often during the last year have you found you cannot stop drinking once started, hope this helps mate .....