CHAMPSS (Choosing Healthy Appetizing Meal Plan Solutions for Seniors)Consumer Satisfaction Survey in EnglishFY 2020-2021

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* 1. Which of the following CHAMPSS restaurants have you eaten at since July 2019? Please check all that apply.

S & E Café

PhoSure

Henry's Hunan

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* 2. How often do you currently eat at a CHAMPSS restaurant prior to the Coronavirus pandemic?

Daily

2-3 times a week

Once a week

Once a month or less

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* 3. How often do you currently eat a meal from a CHAMPSS restaurant now during the pandemic?

Daily

2-3 times a week

Once a week

Once a month or less

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* 4. Please rate the meals and service you receive from S & E Cafe on each the following categories: Skip this question if you did not eat at S & E Cafe.

	Excellent	Good	Need Improvement	Poor
Quality of the food	Quality of the food Excellent	Quality of the food Good	Quality of the food Need Improvement	Quality of the food Poor
Variety of the menu	Variety of the menu Excellent	Variety of the menu Good	Variety of the menu Need Improvement	Variety of the menu Poor
Appearance of the food	Appearance of the food Excellent	Appearance of the food Good	Appearance of the food Need Improvement	Appearance of the food Poor
Temperature of the food	Temperature of the food Excellent	Temperature of the food Good	Temperature of the food Need Improvement	Temperature of the food Poor
Customer service from restaurant staff	Customer service from restaurant staff Excellent	Customer service from restaurant staff Good	Customer service from restaurant staff Need Improvement	Customer service from restaurant staff Poor

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* 5. If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.

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* 6. Please rate the meals and service you receive from PhosSure on each of the following categories. Skip this question if you did not eat at PhosSure.

	Excellent	Good	Need Improvement	Poor
Quality of the food	Quality of the food Excellent	Quality of the food Good	Quality of the food Need Improvement	Quality of the food Poor
Variety of the menu	Variety of the menu Excellent	Variety of the menu Good	Variety of the menu Need Improvement	Variety of the menu Poor
Appearance of the food	Appearance of the food Excellent	Appearance of the food Good	Appearance of the food Need Improvement	Appearance of the food Poor
Temperature of the food	Temperature of the food Excellent	Temperature of the food Good	Temperature of the food Need Improvement	Temperature of the food Poor
Customer service from restaurant staff	Customer service from restaurant staff Excellent	Customer service from restaurant staff Good	Customer service from restaurant staff Need Improvement	Customer service from restaurant staff Poor

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* 7. If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.

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* 8. Please rate the meals and service you receive from Henry's Hunan on the following categories. Skip this question if you did not eat at Henry's Hunan.

	Excellent	Good	Need Improvement	Poor
Quality of the food	Quality of the food Excellent	Quality of the food Good	Quality of the food Need Improvement	Quality of the food Poor
Variety of the menu	Variety of the menu Excellent	Variety of the menu Good	Variety of the menu Need Improvement	Variety of the menu Poor
Appearance of the food	Appearance of the food Excellent	Appearance of the food Good	Appearance of the food Need Improvement	Appearance of the food Poor
Temperature of the food	Temperature of the food Excellent	Temperature of the food Good	Temperature of the food Need Improvement	Temperature of the food Poor
Customer service from restaurant staff	Customer service from restaurant staff Excellent	Customer service from restaurant staff Good	Customer service from restaurant staff Need Improvement	Customer service from restaurant staff Poor

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* 9. If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.

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* 10. Please rate the customer service you received from the program staff at Self-Help for the Elderly when you enrolled or re-enrolled in the CHAMPSS program.

Excellent

Good

Needs Improvement

Poor

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* 11. Do you review the nutrition education available on the CHAMPSS website?

Yes

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* 12. Please rate your agreement with the following statement: The nutrition education information on the website helps me maintain and/or improve my health and well-being.

Strongly Agree

Agree

Disagree

Strongly Disagree

Not applicable

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* 13. If you marked “Disagree” or “Strongly Disagree”, please explain why.

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* 14. What nutrition education topics would you like to learn more about? Mark all topics you're interested in.

Healthy Eating

Weight Gain/Weight Loss

Osteoporosis

Diabetes

Exercise/Fitness

Food Safety

Constipation

Fat & Cholesterol

Vitamins/Supplements

Heart Health

Food and Medication Interaction

High Blood Pressure Management

Brain Health

Other (please specify):

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* 15. Please rate your agreement with the following statements. Because I participate in the CHAMPSS program...

	Strongly Agree	Agree	Disagree	Strongly Disagree
I eat more fruits, vegetables, or whole grains.	I eat more fruits, vegetables, or whole grains. Strongly Agree	I eat more fruits, vegetables, or whole grains. Agree	I eat more fruits, vegetables, or whole grains. Disagree	I eat more fruits, vegetables, or whole grains. Strongly Disagree
I know where to get help with other concerns when I need it.	I know where to get help with other concerns when I need it. Strongly Agree	I know where to get help with other concerns when I need it. Agree	I know where to get help with other concerns when I need it. Disagree	I know where to get help with other concerns when I need it. Strongly Disagree
I am able to live more independently.	I am able to live more independently. Strongly Agree	I am able to live more independently. Agree	I am able to live more independently. Disagree	I am able to live more independently. Strongly Disagree
I feel less isolated and/or more connected to my community.	I feel less isolated and/or more connected to my community. Strongly Agree	I feel less isolated and/or more connected to my community. Agree	I feel less isolated and/or more connected to my community. Disagree	I feel less isolated and/or more connected to my community. Strongly Disagree

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* 16. Please rate your agreement with the following statements about the CHAMPSS website.

	Strongly Agree	Agree	Disagree	Strongly Disagree
The CHAMPSS website is user friendly.	The CHAMPSS website is user friendly. Strongly Agree	The CHAMPSS website is user friendly. Agree	The CHAMPSS website is user friendly. Disagree	The CHAMPSS website is user friendly. Strongly Disagree
It is easy to add meals to my account online.	It is easy to add meals to my account online. Strongly Agree	It is easy to add meals to my account online. Agree	It is easy to add meals to my account online. Disagree	It is easy to add meals to my account online. Strongly Disagree

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* 17. Demographic Information

Age

Under 60

60 - 64

65 - 69

70 - 74

75 - 79

80 - 89

90+

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* 18. Gender

Male

Female

Trans Male

Trans Female

Gender queer/Gender non-binary

Not listed

Decline to state

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* 19. Sexual Orientation/Sexual Identity

Straight/Heterosexual

Bisexual

Gay/Lesbian/Same-Gender Loving

Questioning/Unsure

Decline to state

Not Listed (please specify)

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* 1. Which of the following CHAMPSS restaurants have you eaten at since July 2019? Please check all that apply.

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* 2. How often do you currently eat at a CHAMPSS restaurant prior to the Coronavirus pandemic?

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* 3. How often do you currently eat a meal from a CHAMPSS restaurant now during the pandemic?

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* 4. Please rate the meals and service you receive from S & E Cafe on each the following categories: Skip this question if you did not eat at S & E Cafe.

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* 5. If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.

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* 6. Please rate the meals and service you receive from PhosSure on each of the following categories. Skip this question if you did not eat at PhosSure.

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* 7. If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.

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* 8. Please rate the meals and service you receive from Henry's Hunan on the following categories. Skip this question if you did not eat at Henry's Hunan.

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* 9. If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.

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* 10. Please rate the customer service you received from the program staff at Self-Help for the Elderly when you enrolled or re-enrolled in the CHAMPSS program.

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* 11. Do you review the nutrition education available on the CHAMPSS website?

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* 12. Please rate your agreement with the following statement: The nutrition education information on the website helps me maintain and/or improve my health and well-being.

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* 13. If you marked “Disagree” or “Strongly Disagree”, please explain why.

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* 14. What nutrition education topics would you like to learn more about? Mark all topics you're interested in.

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* 15. Please rate your agreement with the following statements. Because I participate in the CHAMPSS program...

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* 16. Please rate your agreement with the following statements about the CHAMPSS website.

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* 17. Demographic Information Age

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* 18. Gender

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* 19. Sexual Orientation/Sexual Identity

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* 20. Race/Ethnicity

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* 21. Please share other comments, if any.

* 17. Demographic Information

Age