Join our Nutrition Program Empower Your Child's Wellness: Nutrition Program for Children with Autism – Fill Out the Form to Get Started! Basic Information:Child's Full Name *Date of Birth *Gender *MaleFemaleParent/Guardian Contact Information:Phone *Email Address *Date of Initial AssessmentMedical and Health InformationHeight (cm or inches) *Weight (kg or lbs) *AllergiesCurrent MedicationsDiagnosed ConditionsDietary RestrictionsBehavioral and Sensory InformationEating HabitsSensory SensitivitiesFavorite FoodsFoods to AvoidFrequency of Tantrums or Sensory Overload at MealsNutrition GoalsNutritional GoalsFood Varieties to IntroduceDesired Caloric Intake per DaySubmit
