Full Plate Living Pre-Survey

1.First name:(Required.)
2.Last name:(Required.)
3.Preferred email address:
4.Residential address for mailing participant guide:(Required.)
5.Current weight (round up the the nearest whole number):
6.Please rate the following:(Required.)
Poor
Average
Good
Energy Level
Sleep
7.Servings of fiber foods per day (fruits, vegetables, whole grains, beans, nuts/seeds):(Required.)
0 servings
1-2 servings
3-4 servings
5+
Fruit = 1 medium whole fruit, 1 cup cut-up fruit, 1/2 cup dried fruit
Vegetables = 2 cups raw leafy salad greens, 1 cup cut-up vegetables
Whole Grains = 1 slice of bread, 1/2 cup cooked rice, pasta or cereal
Beans = 1/2 cup cooked beans
Nuts/Seeds = 1/4 cup
8.I feel confident in my ability to make over meals to increase daily fiber content:
9.Anything else you'd like us to know?