Breast Milk Testing Intake Survey
Eating organically is:
I eat out at a restaurant:
When I do eat out, I usually eat at:
(names of restaurants you most frequent)
Your answer
What percentage of your diet is organic?
(just your best guess)
Your answer
When I shop for groceries, selecting organic items is:
Where do you usually shop for groceries?
(names of stores)
Your answer
I source organic
How close do you live to a farm?
(approximate miles)
Your answer
Do you garden at home? If so, do you use herbicides or pesticides?
Your answer
Did you change your diet when you became pregnant? How so?
Your answer
How old is your nursing child?
Your answer
How difficult would it be for your family to pay for the 130$ breast milk test out of pocket?
If high concentrations of glyphosate were found in my breast milk, I would:
email adress:
Your answer
Your answer
zip code:
Your answer
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