|
|
McNish's Gluten-Free Goodies If you would like to receive coupons and store ads, please use our contact form located on our CONTACT US PAGE.
|
|
|
|
To our customers we need to show a need for a "Specialty Retail Store" to do this we need your assistance.
By filling out our survey this will give us a better idea on. (1) The need, demand or want for a Gluten-Free Bakery (2) Where the best location of the store will be (3) What size store will be adequate. It takes less then 5min.
|
|
|
|
 |
|
|
|
|
|
|
How Many People are in your household?
|
|
|
|
|
What is the average household income per year?
|
|
|
|
|
|
|
|
|
|
|
|
|
Who in your family is affected by Celiac or other Wheat allergies?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 - 4 years
|
|
|
|
1 year or less
|
|
|
|
|
How long have you or your family member(s) been living with this disease?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 years or more
|
|
|
|
|
1 - 2 years
|
|
|
|
|
|
|
|
|
|
|
|
|
|
What age is this person?
|
|
|
|
|
|
|
|
|
|
What is the gender of this person?
|
|
|
|
|
|
|
|
|
|
|
Male
|
|
|
Female
|
|
|
|
|
|
|
|
|
|
|
Does this person suffer from other food allergies or auto-immune disorders?
|
|
|
|
|
|
|
|
|
|
|
Yes
|
|
|
|
|
|
|
|
No
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please list all other allergies or disorders?
|
|
|
|
|
|
|
|
|
|
How far do you travel to get all your Gluten-Free products per month?
|
|
|
|
|
|
|
|
|
miles
|
|
|
|
|
|
|
|
|
|
|
|
What stores do you currently utilize for your Gluten-Free products?
|
|
|
|
|
|
|
Do you shop online for your Gluten-Free products?
|
|
|
|
|
|
|
|
|
|
Yes
|
|
|
No
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Which online companies do you use the most?
|
|
|
|
|
|
|
Do you feel that you have an adequate choice when it comes to your Gluten-Free options?
|
|
|
|
|
|
|
|
|
Yes
|
|
|
|
|
|
|
|
|
No
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please explain:
|
|
|
|
|
|
|
|
|
|
Would you be interested in a wide selection of frozen foods?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes
|
|
|
|
|
|
|
|
No
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Would you like to be able to purchase cookbooks and other literature on Gluten-Free and Wheat Free living?
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
No
|
|
|
|
|
Yes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
If made available would you like to have an option to purchase fresh baked Gluten-Free foods?
|
|
|
|
|
|
|
|
|
|
|
No
|
|
|
|
|
Yes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
What fresh baked Gluten-Free foods would you most likely purchase? check all that apply
|
|
|
|
|
|
|
|
|
Cake or Mini Cakes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Bagels
|
|
|
Pies & Pastries
|
|
|
Individual Treats
|
|
|
Scones
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Donuts
|
|
|
|
|
|
|
|
Birthday Cakes:
|
|
|
Whole Pies
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fresh & Hot Homemade:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Soups
|
|
|
|
|
|
|
|
|
|
|
Dips & Dressings
|
|
|
|
|
|
|
Sauces
|
|
|
|
|
Salads (potato, pasta, etc)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Individual Entrees (veal parmesan, meatloaf, pastas, fried chicken, etc)
|
|
|
|
|
|
|
|
|
|
|
|
|
Please note anything else you would like to see in the store.
|
|
|
|
|
|
|
If made available would you like to have a store dedicated to Gluten-Free and Wheat Free needs?
|
|
|
|
|
|
|
|
|
|
|
|
No
|
|
|
|
|
Yes
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
What City and State do you currently live in?
|
|
|
|
|
|
|
Comments:
|
|
|
|
|
|
|
|
If you would like to receive a McNish's GF Goodies reusable grocery bag, please check this box: and fill out the information below, the information you give us is used only to send you a canvas bag and to update you on McNish's local events.
|
|
|
|
|
|
|
|
|
|
Name:
|
|
|
|
|
|
|
|
|
|
|
Mailing address:
|
|
|
|
|
|
|
|
City, State, & Zip
|
|
|
|
|
|
|
|
|
|
Email address:
|
|
|
|
|
|
|
Submitting your information is not a requirement to complete the survey, it's our way of thanking you for your assistance.
|
|
|
|
McNish's Gluten-Free Goodies would like to Thank You for taking the time to assist us in serving you better.
|
|
|
|
|
|
|
|
|
|
|
|
|