Community Food Pantry Visitor Survey
Please help us improve by sharing your experience and feedback. Your responses are confidential and help us serve you better.
Your Full Name
First Name
Last Name
What is your age group?
*
Under 18
18-24
25-44
45-64
65 or older
How many people are in your household?
*
How often do you visit the food pantry?
*
First time
Once a month
Twice a month
Weekly
Other
How did you hear about our food pantry?
*
Friend or family
Social services agency
Flyer or poster
Online/website
Other
How do you usually get to the pantry?
*
Walk
Drive
Public transportation
Rideshare or taxi
Other
Please rate your satisfaction with the following aspects:
*
Rows
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Food selection
1
2
3
4
5
Food quality
6
7
8
9
10
Staff helpfulness
11
12
13
14
15
Wait time
16
17
18
19
20
Cleanliness
21
22
23
24
25
Which types of food would you like to receive more often? (Select all that apply)
Fresh fruits & vegetables
Canned goods
Dairy products
Meat/protein
Grains/bread
Other
Do you have any dietary restrictions?
No restrictions
Vegetarian
Vegan
Gluten-free
Other
What could we do to improve your experience at the food pantry?
Would you like to receive updates about the pantry (events, schedule changes, etc.)?
Yes
No
Email address (if you would like to receive updates)
example@example.com
Submit Survey
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