Problem Gambling Website

Resources, Referrals and Information on Problem Gambling for the Central Coast of New South Wales.

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SURVEY

As well as providing a resource, referral and information site, a part of our objective is to gather statistical information to identify how problem gambling affects the community. This data will help community organizations to continually improve service provision and treatment for problem gamblers and their families. We would greatly appreciate your co-operation in answering the following totally confidential questions. No data is collected that can identify you.  Please answer these questions on your own behalf only - do not answer for your relative, partner or friend etc.

Please answer these questions for yourself only.
Do not answer for your relative, partner or friend etc.

Also please feel free to assist one of UNE's students who is investigating the link between commitment to work and gambling.  You must be over 18 years of age, & currently in the workforce. It is completely anonymous. http://www.surveyshare.com/survey/take/?sid=66946

 

Q1. Your State of residence?

Q2. Are you:

i) Someone with a gambling problem?

YES
NO

ii) A friend or family member of a problem gambler?

YES
NO

.Q3.Gender?

Male
Female

Q4. Ethnicity, Are you?

    English Speaking Background?
    Non-English Speaking Background?
    Aboriginal/Torres Straight Islander?

Q5. What is your age group?

Under 20
20-29
30-39
40-49
50-59
60-69
70-79
80 & over

Q6. Marital Status:

Married/Defacto
Single
Divorced/Seperated
Widow

.Q7. How many times did you answer YES to the 20 diagnostic questions?

    6 or less
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20

Q8. What form of gambling do you have problem with?

TAB
Casino
Gaming machines in clubs and hotels
Races/Trots/Greyhounds on course
Other

.Q9. Do you have a disability?

NO
YES........If YES, what type of disability?

Physical
Intellectual

Q10. Do you suffer from any of the following?

Mental health issues
Alcohol addiction
Drug addiction
Sexual issues
Buying issues
Grief issues
Depression as a result of gambling problems
Depression that influences gambling behaviour

Q11. Type of income?

Wages
Own business
Government benefits
Retirement fund
Other


Q12. Level of income?

    Under $20k
    $20 to $50k
    $50 to $100k
    Over $100k

Q13 Do any of the following statements apply to you in relation to problem gambling?

    I am suffering high stress
    I am suffering financial hardship
    My work concentration is negatively affected
    My health is negatively affected
    My relationships are negatively affected
    I am isolated/exiled from my family and friends
    I have constant thoughts of gambling
    I feel my gambling is out of control
    My self esteem is negatively affected
    I have thought of suicide
    I have attempted suicide
    I have been involved in illegal activity to support the habit

 

Thank you for your time

Please click the "submit survey" button which will return you to our homepage
 

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Peninsula Commmunity Centre

 

  
CENTRAL COAST
PROBLEM GAMBLING
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