• The Speech, Language & Learning Center of TN, LLC

     

     

    Food Intake

                 Instructions: Please mark the appropriate box in order to indicate the foods that your child already eats. If your child used to eat a food previously, but does not eat this food anymore, please name this food in the comments section. You can include specific notes if there are any brands that your child prefers, or you can describe a preferred method of preparing the food. The therapist will look for patterns in accepted and rejected foods to determine the need for an evaluation. 

     

     

  • Appetite

  • Time of day your child prefers to eat:
    Description of appetite:               

  • # of preferred foods:
    # of preferred liquids/drinks:

  • Allergies:       

  • Should be Empty: