Copy of Food Research Question Title * 1. Contact Information First and Last Name City State Primary Phone Number Secondary Phone Number Question Title * 2. What is your gender? Female Male Question Title * 3. What age category do you fall into? Under 16 17-19 20-35 36-45 46-56 57-64 65+ Question Title * 4. Do you have any children under the age of 18 living in your home? Yes No Question Title * 5. What is your marital status? Single Single and living with significant other Married Divorced or separated Widowed Question Title * 6. Do you any of the following food allergies or sensitivities? Eggs Nuts Wheat Gluten Soy Milk or milk products None Other (please specify) Question Title * 7. Are you on any special diet? Yes No Question Title * 8. Which of the following types of foods frozen do you typically eat? American Asian French Italian Mediterranean Mexican Indian Other (please specify) Next
