Fall Chef's Table

THANK YOU for signing up for our Fall Chef's Table!

We always strive to offer programming that enables survivors to thrive.  In order to continue to serve you, we need your assistance.  As a participant in the Fall Chef's Table, would you please take this initial CONFIDENTIAL survey.   

Food Choices

How many times a day do you:

How many times a week do you?

How many hours a day do you?

Lifestyle Choices

Each statement below describes how a person might feel about their food and/or lifestyle choices. An example of a food choice would be eating the recommended amounts of fruits and vegetables each day. An example of a lifestyle choice would be, participating in regular physical activity. Please indicate the extent to which you tend to agree or disagree with each statement by marking the box that best describes how you feel. In each case, make your choice in terms of how you feel right now, not what you have felt in the past or would like to feel.

As far as I am concerned, I don't have any food and/or lifestyle choices that need changing.
I have been thinking that I might want to change something about my food and/or lifestyle choices.
I wish I had more ideas on how to solve my food and/or lifestyle choice concern.
I'm not following through with what I had already changed about my food and/or my lifestyle choices as well as I had hoped, and I want to prevent going back to my old ways.
Even though I'm not always successful in changing, I am at least working making better food and/or lifestyle choices
I may need a boost right now to help me maintain the food and/or lifestyle changes I've already made.
Anyone can talk about changing their food and/or lifestyle choices; I'm actually doing something about it.
I guess I have faults, but there is nothing that I really need to change about my food and/or lifestyle choices.

Goals & Access

If yes, what was helpful or needed to accomplish your goal.

If No, what do you need or to do differently to accomplish your goal?

Please use the same confidential PIN you selected in the first survey.

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