Greener by Default - Intake Form
Thank you for your interest in serving more plant-forward meals. Please answer the questions to the best of your abilities. We appreciate your time and will be in touch with you soon!
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Email *
Your full name
Name of hospital or healthcare organization
What is your position within your hospital or organization?
What type of healthcare facility best describes you?
Clear selection
Are you interested in implementing plant-based defaults for your patient menus, staff/visitor cafeteria menus, or both? Select all that apply.
Please email a daily or weekly sample menu for the option(s) selected above, if it is available, or provide a link if menus are accessible online. (Please send to info@greenerbydefault.org)
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Who is your foodservice management company?
What is your primary reason for considering plant-based defaults or plant-forward menus at your facility?
Is there anything you would especially like help with or want Greener by Default to know?

**If you selected ‘Patient Menus’ in as one of your answers for Question 1, please answer the following questions regarding your patient menus:

How many entrees do you offer on your menu each day?

How many entrees do you currently offer that are completely plant-based (no animal products like meat, fish, dairy, and eggs)?
Are plant-based entrees included in the main menu, in a separate section on the menu, or only available if the patient requests vegetarian or vegan options?
Clear selection
What is your menu format?
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How are patient orders taken?
Clear selection
Approximately what percentage of your patient population currently orders plant-based meals?
Do you collect and store data on patient meal choice?
Clear selection
How do you gather patient feedback on meals or patient satisfaction ratings? What questions do you ask? If you use a validated questionnaire, feel free to simply name the tool (e.g., Acute Care Hospital Foodservice Patient Satisfaction Questionnaire).
What are your most popular menu items overall (regardless of whether they are plant-based or animal-based)? If possible, please include proportions of sales or number of units sold.

What is the demographic makeup of your patient population? *Why do we ask this? We strive to create inclusive, culturally relevant menu items that patients find familiar and comforting. Understanding the cultural context of your hospital and the ethnic backgrounds of patient populations helps us create the most inclusive menus with high patient satisfaction.*

Are there particular health conditions or diseases that your healthcare facility treats more often than others? *Why do we ask this? Some health conditions may benefit from eating more or less of certain foods and nutrients. We want to ensure we create menus that benefit the particular conditions and demographics seen within your hospitals.*

**If you selected ‘Staff/Visitor Cafeteria’ in as one of your answers for Question 1, please answer the following questions in regards to your cafeteria menus:

Who are the primary customers?
Clear selection
How is food served? Please select all that apply
How many entrees do you offer on your menu each day?
How many entrees do you currently offer that are completely plant-based (no animal products like meat, fish, dairy, and eggs)?
Are plant-based entrees included in the main menu or only available if the patient requests vegetarian or vegan options?
Clear selection
What are your most popular menu items overall (regardless of whether they are plant-based or animal-based)? If possible, please include proportions of sales or number of units sold.

What is the demographic makeup of your customer base? *Why do we ask this? We strive to create inclusive, culturally relevant menu items that increase diner satisfaction and contribute to a sense of belonging. Understanding the cultural context of your hospital and the ethnic backgrounds of your customers helps us create the most inclusive and successful menus.*

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