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  1. How long have you been attending the Agawam Senior Center for lunch?*
  2. What is your age?*
  3. In what town do you currently live?*
  4. How many days per week do you typically attend the Agawam Senior Center?*
  5. How many days a week do you typically eat lunch at the center?*
  6. How many days a week does your primary meal come from the center?*
  7. Please rate the overall quality of the meals:*
  8. The hot meals are always served hot.*
    Please rate the how often this statement is true.
  9. The Cold meals are always served cold*
  10. The staff are courteous and efficient.*
  11. The time of service is appropriate and consistent.*
  12. The meals served by the Agawam Senior Center meet my nutritional needs.*
  13. The dining room is always clean*
  14. How many servings of fruit do you usually eat?*
    One serving of fruit is one piece of fruit; one half cup chopped, cooked, or canned fruit; or 3/4 cup of juice.
  15. What would encourage you to attend the Agawam Senior Center more often?*
  16. Overall, how would you describe your experience with the staff at the Agawam Senior Center?*
  17. How likely are you to recommend our meals to a friend or family?
  18. Are you aware that the meals provided are free of charge and that we suggest a $3 donation?*
    This donation helps to ensure the continuation of the program for future seniors
  19. Ia m satisfied with the variation of the meals offered on a weekly basis.*
  20. I am satisfied with the taste of the meals.*
  21. I enjoy the presentation of the meals.*
  22. Please leave any additional comments you may have for us.
  23. Follow up from Staff
    If you would like a staff person to follow up with you to clarify any questions you may have, or to give further feedback please leave your name and number below.
  24. Leave This Blank:

  25. This field is not part of the form submission.