Feeding & nutrition questionnaire

Nine short questions about food acceptance, sensory responses and mealtime routines. We email you a clean summary to bring to your next appointment. This is an educational reflection tool — it is not a diagnosis or clinical assessment.

Your name

Email address

Child's first name (optional)

Food acceptance

How many different foods does your child reliably accept?

Which food groups are usually refused?

Sensory profile

How does your child respond to new textures?

Are smells or food appearance a frequent trigger?

Mealtime routine

Are mealtimes usually calm or stressful?

How long does a typical main meal take?

Digestion & growth

How often does your child report tummy pain, constipation or reflux?

Is your child currently taking supplements or medication that affects appetite?

Your priorities

What matters most to you right now?

Anything else to share (optional)

0 of 9 questions answered. For urgent medical concerns contact your healthcare provider.