Debra's Healing Kitchen
Welcome
DHK Podcast
Testimonials
DHK WELLNESS
Store
About
COVID-2020
Contact
Resources
How To Get Started
Dish On Health
Healthy Tips
Videos
Photo Gallery
Previous Events
Recipes
Fish Tacos
Veggie Stir Fry
Post-Assessment Survey
Introduction:
Thank you for your participation in our effort to collect data that will ultimately assist those who want to better their overall health. This survey is designed to collect data based on influencers that affect your attitude and behavior towards eating and making food selections.
Disclaimer:
All information and results related to this survey is for informational purposes only. The information presented is not specific medical advice for any individual. The content of this survey should not substitute for medical advice from a certified health professional. If you have a health problem, speak to your doctor or a health care professional immediately about your concerns.
This survey is anonymous and confidential, so please reply to each question as honestly as possible.
DEMOGRAPHICS
*
Indicates required field
Gender
*
Male
Female
Grade Level
*
Freshman
Sophomore
Junior
Senior
Ethnicity
*
African American
African
Hispanic / Latino
Asian / Pacific Islander
White / Caucasian
Weight Range
*
100 lbs or Less
101 lbs - 134 lbs
135 lbs - 149 lbs
150 lbs - 164 lbs
165 lbs - 174 lbs
175 lbs - 184 lbs
185 lbs - 200 lbs
200 lbs - 214 lbs
215 lbs or More
Height Range
*
5’0” and Under
5’1” - 5’4”
5’5” - 5’8”
5’9” - 6’1”
6’2” - 6’4”
6’5” – 6’7”
6’8” – 7’0”
Number of People in Household
*
0 - 1
2 - 4
5-8
9-12
13 or more
QUESTIONS
There are no right or wrong answers. Your responses to the following questions will help us improve the information we provide during our class session.
1. Have you attempted any healthy lifestyle changes since participating in this class?
*
Yes
No
Select One
If yes, have you noticed any positive changes in your body, how you feel, your energy level?
*
Yes
No
Select One
Comments (if any):
*
Note any comments about improvements to your health.
2. How would you rate the Cooking Demonstrations/Food tastings?
*
Excellent
Good
Fair
Poor
Select one option
3. Did you learn any new recipes or food changes that you will try/have tried outside of class?
*
Yes
No
Select One
4. How would you rate the overall experience of the class?
*
Excellent
Good
Fair
Poor
Select one option
5. What suggestions do you have that can make the class better?
*
List any suggestions for class improvements.
6. What did you learn about healthy eating that you did not know before participating in this class?
*
7. What would you like to change most about your health?
*
8. Do you have a better understanding of your diet and its impact on your mental and physical health?
*
Yes
No
Select One
Comments (if any)
*
Please click on the SUBMIT button below to complete this survey. You will receive a message if a required field was not completed. Otherwise, you will receive a confirmation message that your information was submitted.
Submit
Welcome
DHK Podcast
Testimonials
DHK WELLNESS
Store
About
COVID-2020
Contact
Resources
How To Get Started
Dish On Health
Healthy Tips
Videos
Photo Gallery
Previous Events
Recipes
Fish Tacos
Veggie Stir Fry