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* 1. Age

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* 2. Gender

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* 3. Race

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* 4. How often do you eat meals offered at the nutrition site?

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* 5. How many meals do you eat every day, including meals at your nutrition site?

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

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* 7. What other services are provided at your nutrition site? (Check all that apply)

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* 8. What do you do for meals on days when the neighborhood site is not open....

  Always Sometimes Never
I cook easy to fix meals for myself.
Family or friends provide meals.
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
Food Taste
Food Smell
Food Appearance
Food Variety
Food Temperature
Food Service Time

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* 10. Addition Comments/Suggestions

T