* 1. How old are you?

* 2. What do you do?

* 3. What is your marital, family status and ages of your children if applicable? Please give any other details around this.

* 4. Are you a... Please write any other comments

* 5. How much wine (or alcohol) do you drink each week?

* 6. Do you think you drink too much?

* 7. Why do you drink wine or other alcohol?

* 8. What are your reasons for drinking as much as you do (if applicable)? What influences you to drink and would you like to drink less?

* 9. Do you worry about your long term and internal health from drinking wine or other alcohol?

* 10. If there is anything else you would like to share about your wine (or alcohol) drinking such as needs, habits, issues, addiction and frustrations, please write here, along with any help you might need should you do Janey's wine management course

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