Meal Recipient Feedback

1
What is the name of the food you sampled?* This field is required.Select from the options below.
Please Select
Please Select
African Rice & Beans
Baked Mac and Cheese
Beef Chili Mac
Beef Meatloaf
Beef Sloppy Joe
Beef Stew
Black Eyed Peas and Okra Stew
Chakalaka
Chicken Burrito Bowl
Chicken Chili
Chicken Florentine
Chicken Gravy
Chicken Pot Pie
Chicken Stir Fry
Chickpea Masala Curry
Creamy Lemon Chicken
Herb Oil Chicken
Herb Oil Cod
Hotcakes and Hash Browns
Jollof Rice with Black-Eyed Peas
Lentil Okra & Coconut Stew
Mediterranean Meatballs
Miso Glazed Cod
Miso Glazed Veggie Bowl
Pasta Fagioli
Spicy African Peanut Stew
Spicy Red Red Ghanaian Bean Stew
Turkey Bolognese
Turkey Meatloaf
Turkey Ratatouille
Turkey Tamale Pie
Vegetarian Chili
Veggie Frittata
2
Which describes you best?
Please Select
Please Select
General Consumer
Study Participant for UC Maternal Health Study
Study Participant for CareSource/Cradle Cincinnati MTM Study
3
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
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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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Would you eat this again?
YESNO
5
What would you like our Chef's to make?
6
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
7
How old are you?
Please Select
Please Select
Under 18
18 - 65
Over 65
8
What zipcode do you currently live in or stay at?
9
Food Access
Often True
Sometimes True
Never True
Don't Know or Refused
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 Refused
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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 Refused
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Is there other feedback you’d like to share?
Should be Empty: