sex

Age

Residence

Which forms of gambling have you ever practiced and which during the past year?

What is the largest amount of money you have ever gambled with in 1 day?

Do your parents have problems with gambling?

When you've gambled during the past year, have you ever gone back the next day to win back the money you lost?

Do you ever say that you have won money, when in reality you lost during the past year?

Do you ever think that you have ever had problems with gambling in your life?

Have you ever lost more money in the past year than you had planned?

During the past year, have you ever received comments about your gambling?

In the last year, have you ever felt guilty about gambling or the way you gamble?

In the past year, have you ever thought that you should stop gambling, but at the same time felt that you couldn't?

During the past year, have you ever tried to hide from others that you gamble? For example by hiding money or 'evidence'

In the past year, have you ever argued with others you live with about the way you handle money?

If you've been arguing about money in the last year, did your gambling come up?

Have you ever borrowed money to gamble during the last year and not paid back that money?

Have you ever stayed away from work or school to gamble during the past year?

During the last year, have you borrowed money for gambling or to pay back gambling debts? If yes, please input through whom or what?