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Blank Form (#4)
Are you restless or irritable when trying to cut down or stop gambling?
Yes
No
Do you rely on others to help with money problems caused by gambling?
Yes
No
Have you experienced repeated unsuccessful efforts to control, cut back on, or stop gambling?
Yes
No
Do you have frequent thoughts about gambling (such as reliving past gambling or planning future gambling)?
Yes
No
Have you risked or lost a close relationship, a job, or a school or job opportunity because of gambling?
Yes
No
Have you lied about your gambling habit or tried to hide gambling activities?
Yes
No
Do you often gamble when feeling distressed?
Yes
No
After losing money gambling, do you try to recoup your losses, referred to as chasing losses?
Yes
No
Do you need to gamble with increasing amounts to achieve the desired excitement?
Yes
No
Submit Form
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