Registration Survey

Adulting Nutrition Registration Survey

Please note that by submitting this survey, you consent to Dena Don/Adulting Nutrition using your responses anonymously for marketing purposes.

Full Name: *

Email *

How did you hear about the Adulting Nutrition program? *

Why did you sign up for the Adulting Nutrition program? Please be as specific as possible in your response. *

Please list 3 goals that you hope to accomplish as a result of joining the Adulting Nutrition program. *

Goal 2 *

Goal 3 *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I feel comfortable in my kitchen. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I feel confident in my cooking abilities. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I feel organized when it comes to meal-prep. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I have go-to healthy meal ideas that I enjoy. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I know how to meal-prep for one. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I know how to build a balanced plate. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I am comfortable with the amount of money I am spending on food weekly. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I feel that I spend too much money on takeout. *

Please rate the following on a scale of 1-5 (1=strongly disagree, 5=strongly agree): I feel that I have a healthy relationship with food. *

In what capacity can Dena Don/Adulting Nutrition use your responses to this survey for marketing purposes? Please check all that apply. *

Is there anything else you would like Dena Don/Adulting Nutrition to know?