Nutritional Health Survey

The Nutrition Screening is a short screening that can assess an individual’s nutritional risk. To take the screening, please answer the following questions to the best of your ability.

1. What is your date of birth? (MM/DD/YYYY) This question requires a valid date format of MM/DD/YYYY.

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2. How many people live in your home, including yourself?

Adults:
Children (under 18):

3. What is your ZIP Code?

Nutritional Health Survey - Mi-SOAP 4.0