Healthy Food in Health Care Pledge
Complete the following information for your hospital.
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Email *
Facility Information
Hospital *
Health System, if applicable
Street Address *
City *
State *
Country *
Postal Code *
Contact Information
First Name *
Last Name *
Job Title *
Email *
Phone *
Baseline Data
Please provide the following information about your facility
Total beds
Number of patient meals/meal equivalents served per year
Number of cafeteria meals/meal equivalents served per year
Total food and beverage purchasing budget
Our food service is operated by
If contracted, please provide name of company
Food Purchasing
Our facility purchases our food through...
Group Purchasing Organization (GPO)
Primary Broadline food distribution company
Secondary Broadline food distribution company
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This form was created inside of Health Care Without Harm.