World Trade Center Health Program Nutrition Survey

Form Approved
OMB No. 0920-0953
Exp. Date 8/31/2021

World Trade Center Health Program
State University of New York, Stony Brook

500 Commack Road. Suite 204, Commack, NY 11725 Tel. (631) 855-1200 Fax (631) 630-6297
173 Mineola Blvd, Suite 302, Mineola, NY 11501 Fax (516) 419-5919

Dear Member,
We invite you to take part in this brief survey and to inform us about your experience at the Long Island WTC
Health Program Nutrition Department. It is very important to us that we do whatever we can to improve our
services and ensure we are meeting the needs of 9/11 responders.
Your willingness to take part in this survey is greatly appreciated. We have enclosed a stamped, pre-addressed
envelope for you to mail back to us. We kindly request this survey to be mailed back within 2 weeks of receipt.
Thank you for your time,

Your Long Island Center of Excellence - WTC Health Program Registered Dietitian/Nutritionists.

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency
may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-0953).

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Form Approved
OMB No. 0920-0953
Exp. Date 8/31/2021

1. What do you like most about the WTC Nutrition Program, and would you recommend the program to a
fellow first responder?

2. What was your main concern that would have prevented you from joining the WTC Nutrition program,
and what put your fears to rest?

3. What is the most important outcome you have achieved since starting nutrition counseling? (e.g. weight
loss, lab work, medications, sleep, mood, energy, physical activity, digestion, confidence, knowledge)
 Weight loss
 Lab Work (cholesterol, fasting blood glucose, triglycerides, etc.)
 Medication Management
 Sleep
 Mood
 Energy
 Physical Activity
 Digestion
 Confidence
 Nutrition-related knowledge
 Meal preparation skills
 Other:
4. Are there any aspects of the WTC Nutrition program that we can improve upon? Please let us know how
we can better serve you and fellow responders.

5. Do you have any additional feedback?

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