3-Minute Provider Enrollment Survey

4. Please provide your credentials

The following questions will help us understand more about clinical processes among DUO for Health providers. Please answer each question to the best of your ability.

5. How familiar are you with the effects of food insecurity (i.e., uncertain or limited access to a healthy food supply) on a patient’s chronic disease self-management capacity?

Very familiar

Familiar

Somewhat familiar

Not familiar

7. How often do you refer patients for food assistance programs, such as SNAP, WIC, or a food pantry, as part of your care planning?

8. How often do you include diet screening or assessment as part of your care planning for patients with chronic disease?

10. What printed nutrition resources, if any, do you currently provide directly to patients during the patient encounter?

11. Do you ever refer patients to registered dietitians or nutrition programs?

Yes

12. How many adult patients with diabetes and/or hypertension do you see on average each week?

Less than 25

25-50

51-75

100 or more

13. Roughly what percentage of your patients are Spanish speaking?

The following questions are in regard to your professional opinion

14. How many servings of fruits per day should a patient with diabetes eat for healthy blood sugar control?

15. How many servings of vegetables per day should a patient with diabetes eat for healthy blood sugar control?

16. How many servings of fruits per day should a patient with hypertension eat to support blood pressure control?

17. How many servings of vegetables per day should a patient with hypertension eat to support blood pressure control?

The following questions are about how often you personally eat fruits and vegetables.

18. Do you eat fruits and vegetables as snacks?

Yes, often

Yes, sometimes

Yes, always

19. Do you eat more than one kind of fruit each day?

Yes, often

Yes, sometimes

Yes, always

21. Do you eat more than one kind of vegetable each day?

Yes, sometimes

Yes, often

Yes, always