Community Input Survey Question Title * 1. What is your zip code? Question Title * 2. Please choose your age group: 31-40 41-50 51-60 61-70 71-80 Over 80 Question Title * 3. How often do you eat at a Meals on Wheels People dining site? Never 1 to 2 times a week 3 or more times a week Question Title * 4. How often do you go out to eat at a restaurant? Never 1 to 2 times a week 3 or more times a week Question Title * 5. What meal do you most often eat at restaurants (choose one only)? breakfast lunch dinner coffee or snacks Question Title * 6. How far do you live from a Meals on Wheels People dining site? 1 to 5 miles 6 to 10 miles 11 to 15 miles More than 15 miles Question Title * 7. How far do you usually travel to eat at restaurants? 1 to 5 miles 6 to 10 miles 11 to 15 miles More than 15 miles Question Title * 8. Would you attend a restaurant that was open to the public, which also provided a senior specific donation-based healthy meal option? Yes No Question Title * 9. What type of service would you prefer (choose one)? Senior Center Dining Room Café or Restaurant Take-Out Other (please specify) Done
