GIE Intake Form

Thank you for contacting us to consult about your child’s tube-feeding needs. Please fill out the form below with as much detail as you can, and feel free to contact us with any questions at info@gieaters.com.

Upon receipt of this intake form, our team of professionals will validate that it is safe to proceed with our consultation services and provide you further information around options available to you and your child. We cannot approve ANY weaning plan without evidence of a safe swallow as observed by a therapist, physician, or radiological exam (swallow study). Please be sure to include this information in the intake below.

THANK YOU for taking the time to fill out this intake form. It will help us get to know you and your child much better before we speak in person. We will follow-up with you very shortly. We look forward to being a part of your journey!