Host Data Reporting Form

Thank you for hosting Gambling Disorder Screening Day! Screening Day is an international grassroots initiative made possible by people like you.

Please complete this short Google form to let us know how Screening Day went. While not required, we strongly encourage hosts to complete this form after Screening Day. Data collected are used to improve Screening Day and track its reach, outcomes, and other indicators of progress.

Please do not include any Patient Health Information, such as patient name, on this form.

If you prefer to print a pdf of this form to complete, download a printable PDF of the Host Data Reporting Form.

For any questions about this form or Screening Day, email info@divisiononaddiction.org.

---