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* 1. First name

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* 2. Last name

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* 3. Date of birth

Date

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* 4. Gender

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* 5. Ethnicity

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* 6. Race

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* 7. During the past week, did you eat more than one kind of vegetable each day?

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* 8. Within the next week, how often will you eat more than one kind of vegetable each day?

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* 9. During the past week, did you eat wild rice as part of a meal?

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* 10. Within the next week, how often will you eat wild rice as part of a meal?

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* 11. What other ingredients would you add to the recipe?

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* 12. How likely are you to make the recipe at home?

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* 13. What is a fruit or vegetable you would like to learn more about?

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* 14. How many Diabetes is Not Our Destiny cooking demonstrations have you attended/watched?

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* 15. Have you made any of the recipes?

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* 16. Address

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* 17. Phone number

T