Nutritional Survey

E-mail Address: *
Do you have any of the following illnesses or history of illnesses that have made you change the food you eat?
Diabetes: if yes, please answer questions below	Yes No
Do you see a neurologist?	Yes No
Do you see an ophthalmologist?	Yes No
Do you take insulin?	Yes No
Do you take an oral hypoglycemic?	Yes No
How often do you have your HgA1C taken?	Every 3 months Twice a year Once a year Never Don't Know
Do you see a nephrologist?	Yes No
Do you see a cardiologist?	Yes No
How often do you visit the dentist?	Never Occasionally When I have problems Twice a year
Kidney Disease:	Yes No
Hypertension:	Yes No
Heart Failure/Disease:	Yes No
Stroke:	Yes No
Arthritis:	Yes No
High Cholesterol:	Yes No
Chewing Difficulties:	Yes No
Osteoporosis:	Yes No
Food Allergies:	Yes No
Other:
Are you on any special diets for medical reasons? If on a special diet(s), check all that apply.
Reduced Sodium /Salt:	Yes No
Reduced Sugar:	Yes No
Higher Calorie Diet:	Yes No
Reduced Calorie Diet:	Yes No
Soft Diet/Foods:	Yes No
Other:
Are you taking medication(s) for any of the following diagnoses?
Diabetes/High blood Sugar:	Yes No
High Blood Pressure:	Yes No
High Cholesterol:	Yes No
Anxiety:	Yes No
Depression:	Yes No
Other Medical reasons:
Who do you live with?
What is your current marital status?	Single Married Widow/Widower Separated Divorced
Do you need assistance with any of the following?	Shopping Bathing Walking Cooking Taking medication
Are you aware of the dietary changes to make in order to help control your blood sugar?	Yes No
If yes, are you currently following a diabetic diet as it was explained to you?	Yes No
Do you feel you need more information about how to change your diet for better blood sugar control?	Yes No
How often do you eat the following foods?
a. non-diabetic desserts	Daily 3x weekly 1x weekly 2x monthly 1x monthly Occasionally Never
b. non-diabetic beverages	Daily 3x weekly 1x weekly 2x monthly 1x monthly Occasionally Never
Do you think that you eat the right amount of fruits and vegetables now, or do you think you should eat more?	Right Amount Eat More
In general, would you say your health is?	Excellent Very good Good Fair Poor
In general, would you say your appetite is?	Excellent Very good Good Fair Poor
Have you gained 10 or more pounds in the last 6 months without trying?	Yes No
Have you lost 10 or more pounds in the last 6 months without trying?	Yes No
Are you currently following a special diet?	Yes No
If yes, where did you find out about this diet?	Physician Nurse Dietitian Family/Friend Media(TV, radio, newspapers, magazines) Other
Do you eat some fruits and vegetables every day?	Yes No
Briefly describe what you usually eat and drink during a typical day (including food eaten on weekends)
How many milk products do you consume every day?
Would you like us to forward this survey to your doctor?	Yes No, thanks
If yes, please provide your doctors name and address:
Would you like us to send you a reminder about retaking this survey to compare results?	Yes No, thanks
If yes, when?


* Required

About Us

Our parent company, MagicKitchen.com, has been delivering nutritious, delicious, healthy frozen meals for several years. What MagicKitchen.com heard over and over from customers was that they had relatives or friends who had diabetes or other health issues, and those people needed a meal service designed specifically for the patient.

That's why we developed DMP! Diabetic Meal Programs is committed to enhancing your nutritional health by providing you with supplemental meals. Our diabetic meals will assist you in maintaining an adequate nutritional intake to meet the needs for your age and your medical condition(s), especially if you are having difficulties preparing your own meals at home.

By enhancing your nutritional health you will prevent any health deterioration and loss of independence. In other words, this could assist you in maintaining a good quality of LIFE!

Good nutrition is the key to better health. Over the last 20 years, the prevalence of obesity and overweight Americans has become a national concern, which has been referred to as an epidemic. Experts estimate that approximately 2/3 of US adult males and females are overweight.

A healthy diet provides you with a way of eating which reduces risk for complications such as heart disease and stroke. Healthy eating includes a wide variety of well-balanced food groups. There is no one perfect food, therefore, including these different food groups, while watching portion sizes is key for a healthy diet.

Good nutrition has been proven to keep adults healthier, stronger and out of hospitals and nursing homes longer. In an effort to keep "YOU" healthier, we have designed our diabetic meals to help you achieve just that! Diabetic Meal Programs is committed to enhancing your nutritional health by providing you with delicious, low fat, low sodium and carbohydrate controlled meals delivered right to your door.

Diabetic Meal Programs is your source for diabetic meals, including our Diabetic Meal Plan
and Diabetes Diet Plan. If you are searching on Diabetes Meals, Diabetic Diet Menus or Diabetes Diets, you’re at the right place. Our Diabetic Dinner Delivery service covers the entire US, Alaska, and Hawaii.

Purchasing a Diabetic Food Plan Online on our secure website is convenient. Our Diabetic Meal Plans are delivered to your door. They are delicious and easy to prepare and are ideal for a diabetic diet.

Diabetic Meal Planning can be difficult and confusing- we make it easy. Our six Diabetic Diet Menus feature fully-prepared Diabetic Meals.

This Diabetic Diet program offers a full menu where you may select one of six meal packs consisting of seven Diabetic-Friendly meals each.

A Diabetes Meal Gift is a thoughtful gift for a beloved senior. If you are not sure when your recipient could receive their Food For Diabetics, consider our Food Gift Certificates. Our Food Gift Certificates take the worry out of the Diabetes Food Delivery shipment because recipients can redeem on the date of their choice. Your recipient will be delighted with the ease of either online or phone redemption.