For Parent & CAregivers

Additional Information Survey

Feeding Flock would like to gather additional information to better understand the parents/caregivers who are using our tools. We will use this information to: (a) update our current assessment tools; and (b) develop new assessment tools.

PLEASE NOTE: THIS SURVEY IS OPTIONAL.

 
 
ABOUT YOU
What is your relationship to the child/children for whom you are completing this assessment?
What is the highest education you have completed?
How would you describe your household?
Please select the answer that best describes your household
Please select the answer that best describes your household
Within the past 12 months, we worried about whether our food would run out before we got money to buy more.
Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more
How many children would you like to complete a feeding assessment on
Do you have more than one child with eating challenges?
ADDITIONAL RESEARCH
The Feeding Flock Team conducts research to improve the care of children who struggle with feeding. Would you be interested in participating in new research studies?
May we contact you to gather additional information about your child?
YOUR CONTACT INFO
Your Name
Your Name