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Drinking Habitst
Please enter correct information for us to provide accurate output
Are you currently consuming alcohol?
Yes
No
Have consumed in the past?
Yes
No
Are you planning to quit?
Yes
No
Quantity / Frequency of intake
Daily
Weekly once
Occational drinker
Period of Habit
1yr
1-5yrs
5-10yrs
> 10yrs
Insurance Records
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