Holland bloorview feeding clinic 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your details in the 'COMPLETED BY' and 'DATE COMPLETED' fields. This ensures that the form is properly attributed.
3. Enter your child's name, date of birth, and sex. If applicable, include the medical record number for reference.
4. Indicate any known medical concerns by selecting 'YES' or 'NO'. If yes, list the diagnoses.
5. Describe the feeding problems your child is experiencing and what you hope to learn from the assessment.
6. Specify if your child is on any medications and detail any respiratory issues they may have had.
7. Select how your child eats/drinks and their ability to self-feed from the provided options.
8. Use the chart to indicate which foods and liquids your child accepts, including any special preparation methods.
9. Check any concerns related to feeding that apply to your child, such as coughing or difficulty breathing.
10. Complete sections regarding meal duration, eating positions, and previous help received for feeding/swallowing.
11. List any agencies or therapists currently working with your child for comprehensive support.

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