Family Food Survey  

Name *

First Name

Last Name

Number of household members? *

1

2

3

4

5

6

7

8+

Ages of your household members? *

Select all that apply.

0-24 months

2-4

5-9

10-12

13-15

16-18

19+

How important is it to have family dinner? *

not important

it's not a bad idea

we do it when we can

it's good when it happens

it is a top priority

How often do you have dinner as a family? *

doesn't normally happen

1-2 times a week

3-5 times a week

6-7 times a week

Do you cook with your kids? *

yes

sometimes

no

no kids at home

Do you meal plan? *

always

sometimes

only in my dreams

wait, what's a meal plan?

If so, how often?

daily

weekly

monthly