Breast Milk Testing Intake Survey
Eating organically is:
extremely important to me
somewhat important to me
not something I really think about
I eat out at a restaurant:
more than five times a week
more than three times a week
once a week
When I do eat out, I usually eat at:
(names of restaurants you most frequent)
What percentage of your diet is organic?
(just your best guess)
When I shop for groceries, selecting organic items is:
my number one priority
something I try to do if I can
something I do sometimes
something I do rarely
something I never do
Where do you usually shop for groceries?
(names of stores)
I source organic
fruits and vegetables
packaged and prepared foods
How close do you live to a farm?
Do you garden at home? If so, do you use herbicides or pesticides?
Did you change your diet when you became pregnant? How so?
How old is your nursing child?
How difficult would it be for your family to pay for the 130$ breast milk test out of pocket?
I can comfortably pay for my own test
It would be a bit of a stretch
It would be a hardship; I couldn't do it.
If high concentrations of glyphosate were found in my breast milk, I would:
be very likely to change my diet in attempt to reduce the levels
probably try to change my diet
probably keep my diet the same
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