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What is your gender?
 
Male
 
Female
 
 
 
What is your current age?
 
18-25
 
26-35
 
36-45
 
46-55
 
55+
 
 
 
What is your current marital status?
 
Single
 
Married
 
Divorced
 
Widowed
 
Other
 
 
 
 
How many people are currently living in your household?
 
1
 
2
 
3
 
4
 
5+
 
 
 
Which days of the week are you most likely to shop for groceries?
 
Mon/Tues
 
Wed/Thurs
 
Friday
 
Sat/Sun
 
Does Not Matter
 
 
 
What hours of the day are most convenient for you?
 
1:00am-5:00am
 
6:00am-10:00am
 
11:00am-4:00pm
 
5:00pm-9:00pm
 
10:00pm-12:00am
 
 
 
How often do you shop for groceries?
 
Daily
 
Biweekly
 
Weekly
 
Bimonthly
 
Monthly
 
Other
 
 
 
 
Which of the following foods are most consumed by your household?
 
Grains
 
Vegetables
 
Fruits
 
Rice
 
Other
 
 
 
 
Which of the following foods are least consumed by your household?
 
Grains
 
Vegetables
 
Fruits
 
Rice
 
Other
 
 
 
 
Where do you normally shop for groceries?
   
 
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