Casino Responsible Gambling Self-Assessment Form
Take this brief self-check to reflect on your gambling habits and awareness. Your responses are anonymous and intended for personal insight only.
How often do you find yourself thinking about gambling (past or future)?
*
Never
Rarely
Sometimes
Often
Very often
Have you ever tried to cut back or stop gambling but couldn’t?
*
Never
Rarely
Sometimes
Often
Very often
How often do you gamble with more money than you can afford to lose?
*
Never
Rarely
Sometimes
Often
Very often
Rate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I sometimes feel restless or irritable if I can’t gamble.
1
2
3
4
5
Gambling has caused problems in my relationships or work.
6
7
8
9
10
I chase losses by gambling more to win back money.
11
12
13
14
15
I hide my gambling from others.
16
17
18
19
20
I feel guilt or remorse after gambling.
21
22
23
24
25
How much control do you feel you have over your gambling?
*
1
2
3
4
5
How often do you set limits (time or money) before you gamble?
*
Never
Rarely
Sometimes
Often
Always
Do you ever borrow money or sell possessions to gamble?
*
Never
Rarely
Sometimes
Often
Very often
How would you rate your overall satisfaction with your gambling habits?
*
1
2
3
4
5
How likely are you to seek help or support if you felt your gambling was becoming a problem?
*
Very unlikely
Unlikely
Neutral
Likely
Very likely
Submit Self-Assessment
Should be Empty: