| 1. When you gamble, how often do you go back another day to win back the money you lost?
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| 2. Have you ever claimed to be winning money gambling, but weren't really? In fact, you lost? |
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| 3.
Do you feel you have ever had a problem with gambling? |
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| 4.
Did you ever gamble more than you intended to? |
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| 5.
Have people criticized your gambling? |
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| 6.
Have you ever felt guilty about the way you gamble or what happens when you gamble? |
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| 7.
Have you ever felt like you would like to stop gambling, but didn't think you could? |
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| 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? |
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If you answered "No" to Question 9, do not answer Question 10, and skip to Question 11. |
| 9.
Have money arguments ever centered on your gambling? |
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| 10.
Have you ever borrowed from someone and not paid them back as a result of your gambling? |
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| 11.
Have you ever lost time from work or school due to gambling? |
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12. If you borrowed money to gamble or to pay gambling debts, who or where did you borrow from?
(check “yes” or “no” for each) |
| A. From household money |
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| B.
From your spouse |
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| C.
From other relatives or in-laws |
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| D. From banks, loan companies or credit unions |
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| E. From credit cards |
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| F. From loan sharks |
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| G. You cashed in stocks, bonds or other securities |
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| H. You sold personal or family property |
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| I. You borrowed on your checking account (passed bad checks) |
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