What is the name of the street that you live on:
Which food stores do you shop at most often? Check all that apply.
How often do you shop for food?
What other sources do you get your food from? (Select all that apply).
What mode(s) of transportation do you use to access your food stores? (Select all that apply).
In a typical week, how often do you eat out or eat pre-prepared food? (Examples: fast food, restaurants, pre-prepared meals from grocery store, take-out/delivery)
Do you currently participate in a Farm Share (or Community Supported Agriculture/CSA) program?
Would you like to shop at a community owned grocery store?
Are there any concerns or anything currently lacking, pertaining to food or safety, in your neighborhood that you would care to share?