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* 1. Where do you receive your Home Delivered Meals from?

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* 2. Age

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* 3. Gender

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* 4. Race

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* 5. How long have you been getting meals?

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* 6. How many meals do you eat every day, including home delivered meals?

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* 7. In general, would you say your health is.....

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* 8. What do you do for meals on days when meals are not delivered?

  Always Sometimes Never
I cook  easy to fix meals for myself
Family or friends provide meals
I eat at restaurants
I skip meals or eat less food
I eat food saved from other meals

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* 9. Are you satisfied with the...

  Always Sometimes Never
way the food tastes?
way the food smells?
 way the food looks?
variety of foods?
food temperature
time food arrives
attitude of person who delivers

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* 10. As the result of the home delivered meals program...

  Yes Maybe No
I eat a healthier variety of food
I eat less salt (sodium)
I eat less high fat foods
I can reach/keep a healthy weight
I believe my health has improved and I feel better
I am less hungry during the day
I can continue to live in my own home

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* 11. Additional Comments

T