Mmm! Making Mealtimes Matter Group
Making Mealtimes Matter is a virtual parent education group covering picky eating behaviors. Designed for parents and caregivers of children 2-8 years old. To learn more, read the FAQs at https://www.hillertherapy.com/feeding.

Contact Ellie at ellie@hillertherapy.com
Parent/Caregiver Name *
Phone Number *
Email *
Child's Name *
Child's School
Child's Current Grade
Child's Date of Birth *
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Which session would you like to attend?
Are you available from 8-9 pm on Mondays, 1/9/22 - 2/6/22? *
If not, please provide a few dates and times that work best for your schedule
Share about your child (with regards to feeding and picky eating behaviors) *
What are your goals for your child (with regards to feeding and picky eating behaviors)
Feeding Context
Where does your child typically eat their meals?
What is your child's mealtime schedule (meals and snack breaks)? *
What are your child's typical "success foods" (foods they love and return to)? *
What are your child's typical "difficult foods" (foods they avoid or will not try? *
When and where do these "picky eating" behaviors typically occur? How often?
Clinical History
Have you sought out services to address these feeding challenges? If so, when and what kind? *
Describe any particular feeding incidents (examples of choking, food trauma, excessive avoidance, etc.)? *
Dietary restrictions
Clear selection
Does your child have any allergies? *
Summary
Is there anything else you would like us to know about your child?
This group will be conducted via Zoom, do you have access to a webcam and microphone? *
Payment Details
Making Mealtimes Matter costs $200 for the entire 5-session groups. That comes out to approximately $40 per session. 
Thank you for taking the time to complete this survey! Your registration fee includes all household parents and caregivers
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