Outreach Nutrition Consultation Services Application

Name of Institution/ Dormitory/ School/ Organization

Please fill in the following information
* Compulsory
Name of Institution/ Dormitory/ School/ Organization *
Address *
Flat
Floor
Block
Building Name
Estate/Village Name
Street Name and Number
Area

Contact Person

Name *
Position *
Tel *
Email *
Fax

Service Users of Residential dormitory Institutions

No. of People *
Age Group *
Does the center have/have a nutritionist to provide nutrition services? *
Service Period *
to *
No. of Visits *
Visit Once
Time *

Interested Services

Approximate number of people screened
Budget per time
Approximate number of interviews
Review the menu
Once
Number of times held
Once
Approximate number of participants
Proposed theme
Number of times held
Once
Approximate number of participants
Proposed theme
Provide recipes
Qty
Budget Amount of the Above Services
HKD

Other available information (if applicable)

Types of meals provided
Number and time of meals provided per day
Types of special meals
online booking