South Oaks Gambling Screen

Please note that the following online assessment is presented here for your information and convenience only. JLAP has no way of knowing who is using this online assessment, and no data will be collected when you submit the assessment for scoring. Scoring is made possible by a script that calculates your score based on how you answer the questions. If you would prefer to print this assessment and calculate your score on paper, please open our printer-friendly Adobe PDF version.

1. Please indicate which of the following types of gambling you have done in your lifetime. For each type, mark one answer: "Not at All," "Less than Once a Week," or "Once a Week or More."

Please choose one answer for each statement: Not At All Less Than Once a Week Once a Week or More
a. Played cards for money
b. Bet on horses, dogs, or other animals (at OTB, the track or with a bookie)
c. Bet on sport (parlay cards, with bookie at Jai Alai)
d. Played dice games, including craps, over and under or other dice games
e. Went to casinos (legal or otherwise)
f. Played the numbers or bet on lotteries
g. Played bingo
h. Played the stock and/or commodities market
i. Played slot machines, poker machines, or other gambling machines
j. Bowled, shot pool, played golf, or some other game of skill for money
k. Played pull tabs or "paper" games other than lotteries
(optional question)
l. Some form of gambling not listed above Please specify:

2. What is the largest amount of money you have ever gambled with on any one-day?

 

3. Check which of the following people in your life has (or had) a gambling problem.

 Father  Mother
 Brother/Sister  Spouse/Partner
 Child(ren)  Another Relative
 A Friend or Someone Important in My Life

4. When you gamble, how often do you go back another day to win back money you have lost?

Never Most of the Time
Some of the Time
(less than half the time I lose)		 Every Time I Lose

5. Have you ever claimed to be winning money gambling, but weren't really? In fact, you lost?

Never
Yes, less than half the time I lost
Yes, most of the time

6.Do you feel you have ever had a problem with betting or money gambling?

No
Yes
Yes, in the past, but not now

7. Did you ever gamble more than you intended to? Yes No
8. Have people criticized your betting or told you that you had a problem, regardless of whether or not you thought it was true? Yes No
9. Have you ever felt guilty about the way you gamble, or what happens when you gamble? Yes No
10. Have you ever felt like you would like to stop betting money on gambling, but didn't think you could? Yes No
11. Have you ever hidden betting slips, lottery tickets, gambling money, IOUs, or other signs of betting or gambling from your spouse, children or other important people in your life? Yes No
12. Have you ever argued with people you live with over how you handle money? Yes No
13. (If you answered "Yes" to question 12) Have money arguments ever centered on your gambling? Yes No
14. Have you ever borrowed from someone and not paid them back as a result of your gambling? Yes No
15. Have you ever lost time from work (or school) due to betting money or gambling? Yes No
16. 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
 Yes No
 
b. From your spouse
 Yes No
 
c. From other relatives or in-laws
 Yes No
 
d. From banks, loan companies, or credit unions
 Yes No
 
e. From credit cards
 Yes No
 
f. From loan sharks
 Yes No
 
g. You cashed in stocks, bonds or other securities
 Yes No
 
h. You sold personal or family property
 Yes No
 
i. You borrowed on your checking accounts (passed bad checks)
 Yes No
 
j. You have (had) a credit line with a bookie
 Yes No
 
k. You have (had) a credit line with casino
 Yes No
 
   

             
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