GROUP: _____________ ID: ____________ Attachment F: Activity Worksheet Profile of an Excessive Drinker
Form Approved
OMB No. 0920-xxxx
Expiration date: xx/xx/xxxx
What
they’re thinking when
drinking:
When NOT drinking?
When drinking?
What
they’re doing…
How
they feel when
drinking:
DEMOGRAPHICS
AGE:
________
Circle
responses below
Race/Ethnicity: White Black
Hispanic
Asian
Other:_________
Gender:
Male
Female
Married?
Yes
No
Kids?
Yes
No
(draw their face)
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Caitlin Krulikowski |
File Modified | 0000-00-00 |
File Created | 2021-01-23 |