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0%
 
 
Age
 
60-64
 
65-69
 
70-74
 
75-79
 
80-84
 
85-89
 
90 and Over
 
 
 
Gender
 
Female
 
Male
 
 
 
Race
 
Black/African American
 
White
 
Hispanic
 
Asian
 
American Indian
 
Native Hawaiian/Pacific Islander
 
Other
 
 
 
 
How long have you been getting meals?
 
Less than 1 Year
 
1-3 Years
 
4-6 Years
 
More than 7 Years
 
 
 
How satisified are you with the time the meal is delivered?
 
Very Satisfied
 
Satisfied
 
Dissatisfied
 
 
 
How often do yo miss the meal delivery because you have a schedule conflict?
 
Once Montly
 
2-3 times Monthly
 
Never
 
1 Time Weekly
 
2-4 times Weekly
 
 
How would you rate
Excellent Very Good Good Fair Poor
Variety of meals you get
Quality of meals you get
Friendliness and courtesy of the meal deliverers
Overall, how would you rate the meal service
 
 
 
Do you get hot or frozen meals
 
Hot
 
Frozen

 
 
 
Did you know frozen meals were available
 
Yes
 
No
 
 
 
How often do you prepare meals for yourself? (If never, skip to question 15)
 
Everyday
 
Sometimes
 
Never
 
 
 
What meal do you usually prepare yourself?
 
Breakfast
 
Lunch
 
Supper
 
Snack
 
Weekend Meals

 
 
 
Who prepares your meals now?
 
Family
 
Friend
 
Neighbor
 
Paid Staff
 
Other
 

 
 
 
What meal do they usually prepare for you?
 
Breakfast
 
Lunch
 
Supper
 
Snack
 
Weekend Meals

 
 
 
How often do you see friends, relatives, neighbors?
 
Daily
 
3-5 times weekly
 
Less than once weekly
 
 
 
Additional Comments:
   
 
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