Question Title

* 1. Are you a current resident of New Town/North Segment or Four Bears Segment?

Question Title

* 2. Age:

Question Title

* 3. Gender:

Question Title

* 4. Where do you shop for groceries? (Check all that apply)

Question Title

* 5. How much of your groceries do you buy in New Town? (Check One)

Question Title

* 6. Do you shop for the groceries used in your house? (Check One)

Question Title

* 7. Are you the primary cook in your household? (Check One)

Question Title

* 8. How many people are usually at your house for meals? (Check One)

Question Title

* 9. On average, how many meals per week do you or your family prepare/eat home cooked meal?

Question Title

* 10. On average, how many meals per week do you or your family purchase prepared/takeout/restaurant food?

Question Title

* 11. Which of the following foods do you/would you buy if they were available in New Town? (Check all that apply & list)

Question Title

* 12. What type of beverages do you usually buy in New Town? (Check all that apply)

Question Title

* 13. Do you utilize any food assistance? (Check all that apply)

Question Title

* 14. Do you receive food from any of the following New Town community resources? (Check all that apply)

Question Title

* 15. Do you experience any of the following obstacles or challenges to buying the kind of food that you want? (Check all that apply)

Question Title

* 16. What information or resources would help you to provide healthier food for your household more often? (Check all that apply)

Question Title

* 17. How would you rate the nutritional quality of your diet? (Check one)

Question Title

* 18. How would you rate your overall health?

Question Title

* 19. What suggestions do you have to improve healthy food options in New Town?

T