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Class & Group Survey
Thank you so much for taking the time to fill out this survey. Your input is invaluable and greatly appreciated! This is a survey for future class ideas and group support gatherings. Please feel free to add any ideas or concerns that are not mentioned in the space provided at the end of the survey.
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* Indicates required question
Are you in recovery from an addiction?
Yes
No
Other:
Clear selection
If you answered Yes to being in recovery, how long has it been?
Less than 1 Year
1-2 Years
3-5 Years
6-10 Years
10+ Years
Other:
Clear selection
Are you involved in individual support or recovery support groups?
(select all that apply)
12 Step Programs
SMART Recovery
Moderation Management
Women for Sobriety
Conscious Recovery
Religious Group
Counceling/Individual Therapy
Group Therapy
Other
N/A
Are you interested in learning more about nutrition and how it can help support your health and wellness goals?
Yes
No
Other:
Clear selection
What time of day usually works best for you to attend live classes/groups?
(You can add specific time when you choose "other")
*
Morning
Afternoon
Evening
Other:
Required
What days of the week are usually best for you to attend live classes/groups?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other:
Required
How often would you attend a support group or class?
Once a week
Once a month
Every other week/Twice a month
Other:
What seasons/time of year are you most likely to attend nutrition classes or groups?
Winter
Spring
Summer
Fall
Other:
What are your top 3 questions around the topic of nutrition?
Your answer
Which statement or statements best describes you...
Ugh my diet is the worst, I just can't seem to stick to a plan.
Honestly, I'm just so confused with all the information out there.
I'm always on a diet.
I think I'm eating healthy.
I know a lot about nutrition I just don't follow what I know.
I really struggle with knowing what to eat.
I've tried all the magic potions and pills and I just can't seem to keep the weight off.
Other:
What are your top 3 challenges when it comes to eating healthy?
Emotional/Stress Eating
Lack of planning
Cravings
Snacking when not hungry
Eating quickly
Sweet tooth
Eating out frequently
Large portions
Finding the time to prepare meals
Wine/alcohol
Don't know what I should eat.
Dislike cooking/ don't know how to cook
Family or peer pressure
Unsupportive environment
Other:
Do you experience any of these symptoms or struggles?
(Select all that apply)
weight loss/weight gain
sleep disturbance
chronic pain
depression
anxiety/heart palpitations
mood swings
emotional eating
getting shaky if you don't eat
sometimes get sleepy after I eat
cravings for certain foods
feeling hungry often
headaches/migraines
acne or other skin issues
fatigue
inflammation
allergies
digestive distress ex. IBS, gas, bloating, cramping, heart burn, GERD, constipation, diarrhea etc
Other:
What are your top 1-3 health goals?
Your answer
What topic would you like to learn more about in a class?
Healthy Swaps/ Substitutes/ Trade & Upgrades
How to Optimize Digestion (reduce bloating, gas, heartburn and other uncomfortable digestive issues)
Grocery Store Tips
Stress Reduction Made Easy
How to Build a New Habit
What the bleep should I eat for lasting weight loss?
How to Read a Food Label
The Food Mood Connection
How to Build a Delicious Healthy Plate
The Magic of Water
Other:
Is there anything else would you like to discuss or learn more about in a class or group?
Is there anything else you would like to share?
Your answer
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