Please answer the following questions regarding your gambling in the past 12 months.

1. Yes    No     Have you been preoccupied with reliving past gambling experiences, planning your next gambling venture, and/or thinking of ways in which to get money to gamble?
   
   
2. Yes    No     Have you had to bet in increasing amounts of money in order to achieve the desired excitement?
   
   
3. Yes    No     Have you had repeated unsuccessful efforts to control, cut back, or stop gambling?
   
   
4. Yes    No     Have you felt restless or irritable when attempting to cut down or stop gambling?
   
   
5. Yes    No     Have you gambled to escape problems or to feel better?
   
   
6. Yes    No     After losing money on an occasion, have you come back the next day to get even?
   
   
7. Yes    No     Have you lied to family members, friends, or others to conceal the extent of your gambling?
   
   
8. Yes    No     Have you committed illegal acts such as forgery, fraud, theft, or embezzlement to finance your gambling?
   
   
9. Yes    No     Have you jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling?
   
   
10. Yes    No     Have you relied on others to provide money to relieve a desperate financial situation caused by your gambling?