CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY

Congregate Meal Site Satisfaction Survey

The below questions are intended to help us assess your satisfaction with the

congregate meal program and site. Your input will help us better serve you. 

1. How long have you been attending the meal program?

2. Months Years

3. On average, how many times a week do you attend the meal program?

 0 to 1 times

 2 to 3 times

 4 to 5 times

4. What is your primary purpose for coming to the meal site?

 Conversations with friends and lunch

 A nutritious meal

 Programs and activities

 Other

5. Think about the food you receive from the meal program. Please tell us, how often

are you satisfied with the...

Always Usually Sometimes Rarely Never

how well the menu options meet 

your dietary needs and 

preferences.

overall food quality.

overall menu choices.

temperature of the foods served.

variety of foods offered.

way the food is cooked.

way the food looks.

way the food smells.

way the food tastes.

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD

Professor in Food Science & Human Nutrition, Iowa State University

August 2023
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY 

6. Think about the dining experience at the meal program. Please tell us, how often are you satisfied with the... 

Always Usually Sometimes Rarely Never

cleanliness of the facility.

friendliness of the staff.

helpfulness of the staff.

location of the facility.

overall ambience of the meal site.

overall meal site environment .

7. Think about the programming offered through the meal program. Please tell us, how often are you satisfied with 

the...

Always Usually Sometimes Rarely Never Don’t 

Participate

Not 

available

Better ChoicesBetter Health

Chronic Disease 

Self-Management

Exercise programs 

Foot care

Guest speakers 

(e.g., 

immunizations, 

diabetes, arthritis, 

etc.)

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD

Professor in Food Science & Human Nutrition, Iowa State University

August 2023
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY 

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD

Professor in Food Science & Human Nutrition, Iowa State University

August 2023

Always Usually Sometimes Rarely Never Don’t 

Participate

Not 

available

Health screenings: 

blood pressure, 

blood sugar

Matter of Balance

Nutrition Education

Stepping On

Tai Chi

Water Exercise 

program

8. Please rate your level of agreement with the following statements regarding how the meal program (including the 

meal and programming) has helped you... 

Strongly 

Agree

Agree Undecided Disagree Strongly 

Disagree

eat healthier foods.

gain nutrition and wellness knowledge

helped you remain in your home.

improve your health.

9. Do you have any recommendations to improve the meal program? (NO SCORE)

 No 

 Yes, please describe:
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY 

The following questions help provide us with a general description of our meal 

program participants.

10. What year were you born? _________

11. Are you female or male?

 Female

 Male

 Transgender Female

 Transgender Male

 Non-binary

 Gender not listed above

 Prefer not to answer

12. Which one best describes your race? 

 American Indian or Alaska Native 

 Asian 

 Black or African American

 Hispanic or Latino

 Native Hawaiian or other Pacific islander 

 White 

 Two or more races

 Prefer not to answer

 Other, please describe

13. Which one best describes your ethnicity?

 Hispanic, Latino, or Spanish Origin

 Not Hispanic, Latino, or Spanish Origin

 Prefer not to say

14. What is the highest degree of school you completed? 

 Less than High School

 High School/GED

 Some College

 Associates or Technical School

 Bachelor’s 

 Graduate

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD

Professor in Food Science & Human Nutrition, Iowa State University

August 2023
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY 

15. Are you...? 

 Divorced

 Married 

 Separated

 Single, never married

 Widowed

16. What best describes your living situation?

 Live alone in house, apartment or retirement community

 Live with a child (< 18 years of age) in a house, apartment, or retirement 

community

 Live with spouse, significant other or friend in house, apartment or 

retirement community

 Live with adult children in house, apartment or retirement community

17. Do you follow any special dietary practices?

 Dairy-free

 Diabetes diet

 Gluten-free

 Heart healthy diet (i.e., low fat, low cholesterol, low sodium)

 Restrict red meat or pork

 Vegetarian (includes: vegan, dairy/egg only, fish only) 

 None of the above

 Other

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD

Professor in Food Science & Human Nutrition, Iowa State University

August 2023