Free Feeding Evaluation Template
Feeding Evaluation
[YOUR COMPANY NAME]
Date: [DATE]
This form is designed to methodically assess an individual's ability to consume food and liquids safely and effectively.
This comprehensive evaluation focuses on various aspects such as oral motor skills, swallowing function, behavioral aspects of feeding, dietary preferences, and potential risks associated with feeding.
Evaluation Criteria:
The criteria or performance metrics used for this evaluation include oral motor skills, swallowing function, feeding behavior, dietary preferences, and risk factors associated with feeding. Each criterion will be thoroughly observed and evaluated using a predefined rating scale, which we detail below. Please note, that the higher the rating, the better the individual's ability.
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Criteria |
Description |
Rating (1-5) |
|---|---|---|
|
Oral Motor Skills |
Examine the individual’s ability to control and coordinate their mouth and throat muscles, essential for consuming food. |
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|
Swallowing Function |
Evaluate the individual's ability to swallow foods and liquids safely, without choking or discomfort. |
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|
Feeding Behavior |
Analyze the behavioral aspects of feeding, such as willingness to eat, ability to self-feed, and reactions to different foods and textures. |
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|
Dietary Preferences |
Assess the individual's likes, dislikes, and how varied their diet is, including acceptance of different tastes and textures. |
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Risk Factors |
Identify any potential risks, such as choking risk, malnutrition, or risk of developing food aversion. |
Rating Criteria:
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1: Very Poor
-
2: Poor
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3: Average
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4: Good
-
5: Excellent
Additional Comments and Notes:
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Comments |
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Notes |
