請您花幾分鐘時間提供有關在東南風美食屋 (S & E Café)、越南美食 (Green Bamboo) 和湖南小喫 (Henry's Hunan) 三家提供的CHAMPSS用餐計劃的反饋。您對本問卷調查的回答將得到嚴格保密。我們不會因您的意見而拒絕向您提供服務。我們重視並歡迎您的反饋

Question Title

* 1. 自2019年7月以來,您在以下哪家CHAMPSS合作餐館用過餐?請選擇所有去過的餐館   (Which of the following CHAMPSS restaurants have you eaten at since July 2019. Please mark all that apply.)

Question Title

* 2. 您目前多久一次在CHAMPSS合作餐館用餐? (How often do you currently eat at a CHAMPSS restaurant?)

Question Title

* 3. 請按以下每個項目對東南風美食屋的餐點和服務進行評分:如果您未在東南風美食屋用餐,請跳過本題  (Please rate the meals and service you receive from S & E Café on each of the following categories: Skip this question if you do not eat at S & E Café.)

  極佳  (Excellent) 佳  (Good) 需要加強  (Needs Improvement) 差 (Poor)
餐點品質  (Quality of the food)
菜色多樣性   (Variety of the menu)
餐點外觀  (Appearance of the food)
餐點溫度  (Temperature of the food)
餐館人員的服務   (Customer service from restaurant staff)

Question Title

* 4. 如果您在上列任何一項選了“需要加強”或“差”,請說明理由  (If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.)

Question Title

* 5. 請按以下每個項目對越南美食的餐點和服務進行評分:如果您未在越南美食用餐,請跳過本題  (Please rate the meals and service you receive from Green Bamboo on each of the following categories:  Skip this question if you do not eat at Green Bamboo.)

  極佳  (Excellent) 佳  (Good) 需要加強  (Needs improvement) 差  (Poor)
餐點品質  (Quality of the food)
菜色多樣性   (Variety of the menu)
餐點外觀  (Appearance of the food)
餐點溫度  (Temperature of the food)
餐館人員的服務  (Customer service from restaurant staff)

Question Title

* 6. 如果您在上列任何一項選了“需要加強”或“差”,請說明理由  (If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.)

Question Title

* 7. 請按以下每個項目對湖南小喫的餐點和服務進行評分:如果您未在湖南小喫用餐,請跳過本題  (Please rate the meals and service you receive from Henry’s Hunan on each of the following categories: Skip this question if you do not eat at Henry’s Hunan.)

  極佳  (Excellent) 佳  (Good) 需要加強  (Needs improvement) 差  (Poor)
餐點品質  (Quality of food)
菜色多樣性  (Variety of menu)
餐點外觀  (Appearance of the food)
餐點溫度  (Temperature of the food)
餐館人員的服務  (Customer service from restaurant staff)

Question Title

* 8. 如果您在上列任何一項選了“需要加強”或“差”,請說明理由  (If you checked “Needs Improvement” or “Poor” to any of the questions above, please explain why.)

Question Title

* 9. 請評價當您註冊或重新註冊CHAMPSS計劃時由安老自助服務處的計劃人員向您提供的客戶服務  (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.)

Question Title

* 10. 您是否在CHAMPSS網站上查看過營養教育材料?  (Do you review the nutrition education materials on the CHAMPSS website?)

Question Title

* 11. 請表達您對下列敘述的同意程度:CHAMPSS網站上的營養教育幫助我維持和/或改善健康狀況  (Please rate your agreement with the following statement: The nutrition education on CHAMPSS website helps me maintain and/or improve my health and well-being.)

Question Title

* 12. 如果您選擇“不同意”或“完全不同意”,請簡要說明  (If you marked “Disagree” or “Strongly Disagree”, please briefly explain.)

Question Title

* 13. 您想進一步了解哪些營養教育主題?您可以選擇多項  (What nutrition education topics would you like to learn more about? Mark all topics you're interested in.)

Question Title

* 14. 請表達您對下列敘述的同意程度:參加了營養餐計劃後...  (Please rate your agreement with the following statements: Because I participate in the nutrition program...)

  完全同意 (Strongly agree) 同意 (Agree) 不同意 (Disagree) 完全不同意 (Strongly disagree)
我吃到了更多的水果以及蔬菜  (I eat more fruits and vegetables.)
我知道當有其他需求時應該去哪裏尋求幫助  (I know where to get help with other concerns when I need it.)
我能夠更加獨立地生活  (I am able to live more independently.)
我因此減輕了我的孤立感且/或感覺與我的社區聯系更緊密了一些  (I feel less isolated and/or more connected to my community.)

Question Title

* 15. 請表達您對CHAMPSS網站相關敘述的同意程度   (Please rate your agreement with the following statements about the CHAMPSS website.) https://www.sfchampss.org/

  完全同意  (Strongly agree) 同意 (Agree) 不同意  (Disagree) 完全不同意  (Strongly disagree)
CHAMPSS網站易於使用  (The CHAMPSS website is user friendly.)
我能夠輕松在網上加餐到我的賬戶中  (It is easy to add meals to my account online.)

Question Title

* 16. 人口統計資訊  (Demographics)
年齡  (Age)

Question Title

* 17. 性別 (Gender)

Question Title

* 18. 族裔(請只選擇一項)(Race/Ethnicity)

Question Title

* 19. 請您在此分享其他評論  (Please share any other comments you may have.)

T