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CAGE Questionnaire for Seniors

Before seeing your physician, you might want to print out and then complete the following CAGE questionnaire. It will help your doctor and you better manage your medical needs. Answer as many questions as you can.

Have you ever considered Cutting down on your alcohol intake?
Yes
No

Do people Annoy you by criticizing your drinking?
Yes
No

Have you ever felt bad or Guilty about your drinking?
Yes
No

Have you ever had an alcoholic drink first thing in the morning (Eyeopener) to steady your nerves or get rid of a hangover?
Yes
No

Medical Questionnaire Geriatric Depression Scale
ADAM (men only) Epworth Sleepiness Questionnaire




  

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