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DAC-HFC 2021 Member Needs Assessment

The DAC and HFC are committed to meeting the needs of our clients and families through a variety of programs and services. The information in this survey is vital to our improving our programs with focus on each individuals physical, emotional, nutritional, and educational needs.


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1.  Name   (Required)

2.  Email   (Required)

3.  Do you plan on renewing your membership in 2021?   (Required)

Yes
No
4.  If yes to question #3, what level of membership will you be joining?   (Required)




5.  What are your favorite programs of the DAC and HFC Cont.   (Required)
























6.  What are your LEAST favorite programs of the DAC and HFC Cont.   (Required)
























7.  How do you participate in DAC and HFC Programs?   (Required)




8.  How has COVID-19 affected your participation in DAC and HFC Programs?   (Required)





9.  Have you or your family experience any of the following due to COVID-19? Select all that are applicable.   (Required)











10.  How would you rate your overall health?   (Required)




11.  How well do you understand how your diet and exercise contribute to your risk of cancer, heart disease, diabetes, and chronic illness?   (Required)




12.  Do you suffer from or have your experienced any of the following conditions?   (Required)







13.  How often do you eat fresh fruits and vegetables?   (Required)




14.  How often do you exercise?   (Required)




15.  Do you get regular cancer screenings and wellness check-ups?   (Required)

Yes
No
16.  Please share anything additional you would like to about your health, wellness, or needs you may have. You can also share program ideas you may have.  

   
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