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NJ Provider Nutrition & Fitness Survey
RequiredRequired Question(s)
Progress: 
 


The following information will allow the Family Resource Network to customize the GetFIT program to meet the needs of the individuals you serve within your professional field.
 

Nutrition
 
Required 1.

Do you use standard guidelines for meal planning?
(If yes, what sources are used for these guidelines)
Yes
No
  • Comment:

  • 500 characters left.
Required 2.

Day to Day meal preparation decisions are made by:

 

50 characters left.
Required 3.

Where do program participants eat their meals?
Alone
In a group
Other  
Required 4.

Approximately how many servings of fruits and vegetables each day per person?

 

50 characters left.

Physical Activity
 
Required 5.

How often do program participants exercise?
Never
Rarely
Weekly
A couple of times a week
Most days
Required 6.

Exercise is.....
Voluntary
Required
Required 7.

Do your program participants currently participate in any of the following fitness, sports, or health programs:
 Never Seasonally Monthly Weekly Daily 
Locally-sponsored fitness or sports programs
Self fitness (running, walking, at home exercises)
Local gyms or health clubs
  • Comment:

  • 500 characters left.
Required 8.

Would your program participants exercise more if any of the following were more available & accessible:
 No Yes-daytime Yes-evening Yes-weekend I do not know 
Exercise equipment
Active (ex. group sports)
Tai Chi, Yoga, Pilates, etc.
Aerobics
Family fitness programs
Common interest groups
Required 9.

Do you have a structured, formalized fitness program?
Yes
No
10.

If yes, would you share your plan with GetFIT?
Yes
No
  • Comment:

  • 500 characters left.