Copy of St. Mary's Nutrition Center Program Survey 2008Copy of St. Mary's Nutrition Center Program Survey 2008

St. Mary's Nutrition Center is part of St. Mary’s Health System. Located in the heart of Lewiston, ME the mission of the Center is to improve the nutritional status of Maine residents through advocacy work and education programs that provide access to healthy food, nutrition education and support, and opportunities to grow one’s own food. We appreciate you taking the time to fill out our program survey. Your answers will help us expand and improve upon the classes and workshops we offer. We look forward to hearing from you! Thank you.

1. I live in:

I live in: City/Town:
ZIP/Postal Code:
Email Address (please enter if you'd like to be part of the raffle):

2. I am between the ages of:

I am between the ages of: 18-25 years

26-39 years

40-54 years

55-64 years

65 years and over

3. Are you familiar with the Nutrition Center?

Are you familiar with the Nutrition Center? Yes

How did you learn about it?

4. I would attend a Nutrition Presentation on one or more of the following topics (check all that apply):

I would attend a Nutrition Presentation on one or more of the following topics (check all that apply): Diabetes

Pre-Diabetes

Irritable Bowel Syndrome

Weight Management

Cardiovascular Disease

Understanding Nutrtion: Fats, Carbs, Proteins

Diet and Depression

Sports Nutrition

Lactose Intolerance

Nutrition and Cancer

Other (please specify)

5. I would attend a Cooking Class on one or more of the following topics:

I would attend a Cooking Class on one or more of the following topics: Eating for One or Two

Fun of Cooking! (Cooking for Kids and Parents)

Cooking in Bulk

Eating on a Budget

30 Minute Meals

Ethnic Cuisine- Chinese, Italian, Indian

Diabetes Cooking

Vegetarian Cooking

Other (please specify)

6. I would be interested in attending one or more of the following Support Groups:

I would be interested in attending one or more of the following Support Groups: Weight Management

Living Gluten Free

Diabetes Management

Smoking Cessation

Eating Well with Cancer

Eating Disorder Recovery

Other (please specify)

7. I like cooking classes to be (check all that apply):

I like cooking classes to be (check all that apply): Participatory where I help prepare the food

A cooking demonstration where I watch the food be prepared

Taught by a professional chef or restaurant owner

Include nutrition information and tips on healthy eating

Other (please specify)

8. The best days for me to attend a class or presentation are:

The best days for me to attend a class or presentation are: Monday

Tuesday

Wednesday

Thursday

Friday

Weekends

9. The best time(s) for me to attend a class or presentation is:

The best time(s) for me to attend a class or presentation is: Morning between 9am- 12pm

Afternoon 12pm- 5pm

Evening 5pm to 9pm

10. I would feel comfortable paying the following for a Nutrition Presentation or Cooking Class:

I would feel comfortable paying the following for a Nutrition Presentation or Cooking Class: $5-$10

$10-$15

$15-$20

Other (please specify)

Copy of St. Mary's Nutrition Center Program Survey 2008
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Copy of St. Mary's Nutrition Center Program Survey 2008
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