Download and Print
Don’t want to fill in the form online? You can download and print the form here.
Send to Kid Talk
PO Box 34
Victoria, MN 55386
Your case history and any other requested information must be received no later than one week before your scheduled appointment.
INSTRUCTIONS: Check off any food that your child would easily accept to eat. Several items are listed under each section. The “Seasonings and Condiments” section describes flavors your child would eat at any meal.