The following is a quiz designed to give feedback on your gambling behaviors. This is not a diagnosis and in no way
replaces a formal assessment with a clinical professional. Your answers are kept completely confidential. No identifying
information will be kept. Some information may be collected for research purposes.
 
     
  1.   My age is  
    Under 18
18-24
25-34
35-44
45-54
55-64
65 and older
 
  2.   I am  
    Female
Male
 
  3.   In the past 3 months, how often have you gambled on:  
   
None 1-5 6-10 11-15 More Than 16
Bingo
Casino Machines
Table Games at a casino or card room
Texas Hold’ em or another poker game outside of a casino
Raffle tickets
Sports betting
Internet betting/casinos (for real money)
Horse or dog racing (not over the internet)
Lotto/Scratch tickets
Other
 
  4.   When gambling in the past three months, how often did you set a spending limit that you didn’t keep?  
   
None 1-5 6-10 11-15 More Than 16
 
  5.   In the past three months, a day or two after losing, how often have you gambled to win back the money lost?  
   
None 1-5 6-10 11-15 More Than 16