Meal Planning Survey

FIT MC Meal Planning Survey

Please list medical history prevalent to diet for each member of your household. (i.e. diabetes, high blood pressure, allergies, food intolerances, etc.)

What are a few "go-to" meals for your household (be honest!)? Is there a particular food group your household diet favors (grains, protein, fats, fruits, vegetables, sweets)? Is there a particular food group your household diet seriously lacks?

How many days per week do you eat breakfast at home? (If number varies by household member, select other and explain)

How many days per week do you eat lunch at home? (If number varies by household member, select other and explain)

How many days per week do you eat dinner at home? (If number varies by household member, select other and explain)

Does your household have any evening activities that conflict with eating at home? If yes, how often?

If given the option, would you rather go to the grocery store

Once per month

Bi-weekly

Once per week

2 or more days per week

If given the option, would you rather prepare most food

Once at the beginning of the week

Each night as needed

A little of both

Does your household have a monthly/weekly grocery budget? (If yes, please include dollar amount)

Are there any types of food or specific foods that your household will NOT eat? (Example: Our family does not like spicy food or my husband and I like spicy food but my daughter does not)