Nutrition Post-Sample Survey

General Info

What, Who, Where & How?

1. What kind of resources did you receive from Hodgson Mill? (check all that apply)*

2. In what setting(s) did you distribute these samples? (check all that apply)*

3. How did you primarily distribute your product samples/literature?*

4. To which population(s) did you distribute these samples? (check all that apply)*

5. Did you recommend these samples to patients to help address any of the following conditions? (check all that apply)*

What was response?

6. Which of the following BEST describes how the samples are received & used by patients at your practice?*

7. How would you respond to this statement: "Using Hodgson Mill's sample program was helpful to me and my patients."*

e.g. Literature specific to product samples (oat bran, flax seed, chia) Literature on general whole grain benefits, Gluten free diet info, Recipes - gluten free or whole grain; or more/different coupons

e.g. Would you recommend, how you like to use samples, what patients like about it. Also any tips, testimonials, impact on practice

May we quote your text answers in outreach, literature or advertising to other health professionals about our sample program? (We generally attribute using first name, last initial and title.)*

Would you like to receive quarterly e-newsletter updates from Hodgson MIll geared toward health professionals?*

May include reminders about application opportunities for samples, product info, nutrition tips, web resources

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1100 Stevens Avenue, Effingham Illinois 62401