Today's date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Name * Street address Zip code Email address * Phone number What brings you to Suppers? (Check all that apply.) * I want to learn how to prepare delicious, healthy food and/or find recipes I want to develop a palate for healthy food I have a diagnosis I would like to improve or turn around I experience some of the problems or symptoms associated with low blood sugar or poor mood chemistry (e.g. depression, fatigue, cravings, poor concentration, etc.) I would like to be less dependent on medications I want to lose weight I have a professional interest I'm concerned with the health of a loved one and have come to support him/her I need support in living according to my intentions to lead a healthier life Other (please specify below) What are your other reasons for participating (if you checked "other" above)? How did you hear about Suppers? * Practitioner referral Educational workshop Friend or family member e-Newsletter Purple Apron Press (print newsletter) Social media Website Advertisement Place of worship Trenton Farmers Market Princeton Public Library event Sourcing Health Locally Current Suppers participant Suppers staff/board member Other (specify below) Please specify your "other" response (if you checked "other" above). If you checked off "Practitioner referral" above, please specify the practitioner, if so inclined. Which topics interest you? (Check all that apply.) * Alzheimer's/Dementia Arthritis Autoimmune Bone loss Blood sugar Brain health/Brain fog Cancer Celiac disease Cognitive decline Concerns for loved one Cooking Depression/anxiety/mood Diabetes/Pre-diabetes Digestive Health Emotional eating Fatigue Fermentation Food allergies/sensitivities Food addiction/cravings High blood pressure High cholesterol Immune support Men's health Parenting Recovery Thyroid/Endocrine issues Weight management Women's health Other (please specify below) What other topics interest you (if you checked "other" above)? How would you describe your style of eating? Gluten free Low carb Macrobiotic Omnivore Paleo Raw vegan Vegan Vegetarian What time of day are you generally available for events? (Check all that apply.) Breakfast Lunch Dinner Weekdays Weekends How many people depend on you for meals, including yourself? What would you most like to accomplish in this program?