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Infant Feeding Plan

*All fields are required for us to better assist you.

Child's Name:
Date:
Date of Birth:
Does the child take a bottle?  Yes    No 
Is the bottle warmed?  Yes    No 
Does the child hold its own bottle?  Yes    No 
Can the child feed itself?  Yes    No 
Does the child eat:
Strained Foods

Baby Foods

Formula
Whole Milk

Table Food

Other
What type of formula is used? 
Amount of formula to be given? 
Does the child take a pacifier?  Yes    No  At what time(s)? 
Food Likes:

Food Dislikes:

Allergies (including any pre-mixed formulas): 

Child's Schedule

Breakfast
Time:
Type & approximate amount of food:

Lunch
Time:
Type & approximate amount of food:

Dinner
Time:
Type & approximate amount of food:

Morning Nap Time:
 
Afternoon Nap Time:

Instructions for introduction of solid food

Signatures needed upon visit to the facility.







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