Meal Recipient Feedback

1
What is the name of the food you sampled?* This field is required.
2
How do you rate your meal?
1= Poor
2= Fair
3= Good
4= Very Good
5 = Excellent
How satisfied were you with the food overall? (How much did you like it?)
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How was the overall appearance of the food? (How did it look?)
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How was the flavor of the item? (How did it taste?)
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How was the texture of the item? (How did it feel in your mouth?)
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How satisfied were you with the food overall? (How much did you like it?)
How was the overall appearance of the food? (How did it look?)
How was the flavor of the item? (How did it taste?)
How was the texture of the item? (How did it feel in your mouth?)
1= Poor
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2= Fair
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3= Good
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4= Very Good
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5 = Excellent
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1= Poor
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2= Fair
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3= Good
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4= Very Good
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5 = Excellent
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1= Poor
Row 2, Column 0
2= Fair
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3= Good
Row 2, Column 2
4= Very Good
Row 2, Column 3
5 = Excellent
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1= Poor
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2= Fair
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3= Good
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4= Very Good
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5 = Excellent
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Would you eat this again?
YESNO
4
What would you like our Chef's to make?
5
Do you have any of the following Health Conditions?
High blood sugar: Pre-Diabetes or Type 2 Diabetes
High blood pressure
High cholesterol
Overweight/obesity
None
Other
6
How old are you?
Please Select
Please Select
Under 18
18 - 65
Over 65
7
What zipcode do you currently live in or stay at?
8
Food Access
Often True
Sometimes True
Never True
Don't Know or Decline
Within the past 12 months, did you worry whether your food would run out before you had money to buy more
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Within the past 12 months, did the food you bought just not last and you didn’t have money to get more?
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Within the past 12 months, did you worry whether your food would run out before you had money to buy more
Within the past 12 months, did the food you bought just not last and you didn’t have money to get more?
Often True
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Sometimes True
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Never True
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Don't Know or Decline
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Often True
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Sometimes True
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Never True
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Don't Know or Decline
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Is there other feedback you’d like to share?
Should be Empty: