Question 1. When you gamble, how often do you go back on another day to win back money you lost?
Never , or, Some of the time (less than half of the time) I lost Most of the time I
lost , or, Every time I lost
Question 2.
Have you ever claimed to be winning money gambling but weren't really? In fact you lost?
Never or never gamble Yes, less than half of the time I
lost ,
or, Yes, most of the time
Question 3. Do you feel you have ever had a problem with gambling?
No Yes, in the past, but not
now , or, Yes
Question 4. Did you ever gamble more than you intended to?
Yes No
Question 5.
Have people criticised your gambling?
Yes No
Question 6. Have you ever felt guilty about the way you gamble or what happens when you gamble?
Yes No
Question 7. Have you ever felt like you would like to stop gambling, but
didn't think you could?
Yes No
Question 8. Have you ever hidden betting slips, lottery tickets, gambling money, or other signs of gambling from your spouse, children or other important people in your life?
Yes No
Question 9a. Have you ever argued with people you live with over how you handle money?
Yes No
Question 9b.
If you answered yes to the previous question: have money arguments ever centred on your gambling?
Yes No
Question 10. Have you ever borrowed from someone and not paid them back as a result of your gambling?
Yes No
Question 11 .Have you ever lost time from work (or school) due to gambling?
Yes No
If you borrowed money to gamble or pay gambling debts, who or where did you borrow from (check "yes" or "no" for each)?
Question 12. From household money?
Yes No
Question 13. From your spouse?
Yes No
Question 14. From other relatives or in-laws?
Yes No
Question 15. From banks, loan companies or credit unions?
Yes No
Question 16. From credit cards?
Yes No
Question 17. From loan sharks?
Yes No
Question 18.
You cashed in stocks, bonds or other securities?
Yes No
Question 19. You sold personal or family property?
Yes No
Question 20. You borrowed on your cheque account (passed bad cheques)?
Yes No
