TXHC-Healthy Food Survey 2020 Question Title * 1. Please check where you live: Bloomington (Zip code: 77951) Inez (Zip code: 77968) McFadden (Zip code: 77973) Nursery (Zip code: 77976) Placedo (Zip code: 77977) Telferner (Zip code: 77988) Victoria (Zip code: 77901) Victoria (Zip code: 77902) Victoria (Zip code: 77904) Victoria (Zip code: 77905) Question Title * 2. How many people do you food shop for in your household? 1-2 3-4 5+ Question Title * 3. How many children (if any) are in: *Enter a number in the field (use 0 if none)* Pre-K (0-4yrs) Elementary School (K-5th) Middle School (6th-8th) High School (9th-12th) None Question Title * 4. What is your annual household income? Less than $10,000 $10,000-$19,999 $20,000-$29,999 $30,000-$39,999 $40,000-$49,999 $50,000-$59,999 Over $60,000 Question Title * 5. How often do you shop for food? 1x week 2x week 3x week Every other week Question Title * 6. Where do you get most of the food you eat? Take out, restaurant, or fast food Farmer's market Garden (home or community) or local farm Supermarket/ grocery store Food pantry Other (please specify) Question Title * 7. Why do you buy most of your food there? Close to home Not able to cook at home Good products Low prices Nice place Near public transportation Only option They accept SNAP or WIC Other (please specify) Question Title * 8. Please rank: How do you choose a restaurant?(in order from 1-6. with 6 being least likely) Question Title * 9. Is a healthy menu option at restaurants an important issue to you? Yes No I don't know Question Title * 10. How many healthy restaurant options do you know of? 0-1 healthy restaurant options 2-4 healthy restaurant options 5+ healthy restaurant options Question Title * 11. How do you get to the place you buy food? Community transit bus Own vehicle Ride for free with someone Walk Other (please specify) Question Title * 12. How would you rate your general health? Excellent Fair Good Poor Question Title * 13. How often do you eat fruits or vegetables? Once a day 2-4 times a day 5 or more times a day Once a week or less Other (please specify) Question Title * 14. Please rank: How important is it that the food being provided to you is?(in order from 1-6. with 6 being least likely) Question Title * 15. Which of the following factors (if any) stops you from buying fruit and vegetables? Stores are too hard to get to Prices are too expensive Poor quality where you shop Not available where you shop Not enough time to prepare them Unsure of how to prepare them Don't like them Not enough to feed everyone in your home Nothing Other (please specify) Done
