SD - Infant Feeding Intake Form
INFANT FEEDING INTAKE FORM
Thank you for taking the time to complete the infant feeding intake form.  The information in this form will be used at your consultation with Dr. Liu to determine if there is a physical oral problem affecting your ability to breastfeed or bottle feed your baby.
PERSONAL DETAILS
Please enter the personal details of your INFANT below.
PARENT CONTACT INFORMATION
INFANT BIRTH INFORMATION
MOTHER'S NURSING HISTORY
INFANT FEEDING HISTORY
    
OTHER
Please answer "yes" or "no" to the following questions.
APPOINTMENT BOOKING AND CONSENT
When you press SUBMIT, you will be directed to a BOOKING SCREEN... 

If you do not wish to book an appointment, please close the window by pressing the X in the top right hand corner.  

If you do wish to book a tentative appointment, please choose a time that best suits your schedule.  Following the booking, you will:
1) receive a phone call from Soni Dentistry to:
 a) clarify questions from your intake form
 b) secure your booking time 
 c) answer any questions you may have
2) receive an email  to instruct you what you need to do, before Tuesday, to prepare for your appointment with Dr. Liu 

If you have booked a tentative appointment and HAVE NOT HEARD FROM US or UNABLE TO BOOK due to a browser conflict, please call the office at 519-453-5111 (1).

Thank you for entrusting us with your baby's care.