Assessment of Garnet Health Medical Center’s Food Pantry Lists to Address Food Insecurity

Among Patients

SURVEY
1. How important do you think reliable access to nutritious food is to maintain good health?

☐ Very important

☐ Important

☐ Neither important nor unimportant

☐ Unimportant

☐ Very unimportant

2. Upon discharge you will be given a list of food pantries located in Orange and Sullivan counties.
How helpful do you think this list will be to you?

☐ Very helpful

☐ Helpful

☐ Neither helpful nor unhelpful

☐ Not helpful

☐ Very unhelpful

3. Within how many days will you be able to visit a food pantry after you are discharged?

☐ 1-2

☐ 3-4

☐ 5-6

☐ 7+

4. Which method of transportation do you have access to?

☐ Car

☐ Bike

☐ Cab/taxi

☐ Public transit (bus, train, etc.)

☐ Other: __________________
Assessment of Garnet Health Medical Center’s Food Pantry Lists to Address Food Insecurity
Among Patients
5. Which food storage and/or cooking equipment do you have access to? Select all that apply.

☐ Stove

☐ Oven

☐ Microwave

☐ Refrigerator

6. What is your age range?

☐ 18-19

☐ 20-29

☐ 30-39

☐ 40-49

☐ 50-59

☐ 60-64

☐ 65+

7. How many people are in your household? ____________