Mast Questionnaire
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Your contact details
Name 
Date of Birth      
Address 
Post Code
Telephone 
Fax (optional)
Mobile (optional) 
E-mail address 

Please answer every question

  Yes No
1 Do you feel you are a normal drinker?
2 Have you ever awakened the morning after some drinking and found that you could not remember a part of the evening before?
3 Does your wife (husband), girlfriend (boyfriend), and/or parents ever worry or complain about your drinking?
4 Can you stop drinking without a struggle after one or two drinks?
5 Do you ever feel guilty about your drinking?
6 Do your friends or relatives think you are a normal drinker?
7 Do you ever try to limit your drinking to certain times of the day or to certain places?
8 Are you always able to stop drinking when you want to?
9 Have you ever attended a meeting of Alcoholics Anonymous (AA) because of your own drinking?
10 Have you been in fights when drinking?
11 Has drinking ever created problems with you and your wife (husband) or girlfriend (boyfriend)?
12 Has your wife (husband), girlfriend (boyfriend), or other family member ever gone to anyone for help about your drinking?
13 Have you ever lost friends because of your drinking?
14 Have you ever been in trouble at work because of drinking?
15 Have you ever lost a job because of drinking?
16 Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?
17 Do you ever drink in the morning?
18 You ever been told you have liver trouble? Cirrhosis?
19 Have you ever had delirium tremens (DTs), severe shaking, heard voices, or seen things after heavy drinking?
20 Have you ever gone to anyone for help about your drinking?
21 Have you ever been in a hospital because of drinking?
22 Have you ever been seen at a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was part of the problem?
23 Have you ever been seen at a psychiatric or mental health clinic, or gone to any doctor, social worker, or clergyman for help with an emotional problem related to drinking?
24 Have you ever been arrested, even for a few hours, because of drunken behaviour?
25 Have you ever been arrested for drink driving?

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