Submit your PFD Family Story

Patient with PFD's First Name *

Age *

Age: years or months *

year(s)
month(s)

Picture *

In the United States? *

State *

Country *

Please describe your or your child's feeding, eating, or swallowing challenges. *

Have you on your child received a formal diagnosis of PFD on you or your child’s medical records? *

At what age was the diagnosis received? *

What type of insurance do you have? *

What percentage of your monthly budget goes to supporting your or your child’s feeding difficulties? *

Does insurance cover any / all medical costs? *

Please summarize your PFD journey in 7-9 sentences and provide any relevant details or thoughts on how a diagnosis or coverage would have changed the trajectory at the time. Please refer to feeding therapy and programs using general terms rather than official program names. *

Please share what having coverage for would mean to you/your family. Your entry will be reviewed and may be edited for length or content. *

Your name *

Your email *

Consent *

By submitting this form you agree to our media release and confirm that you are 18 years of age or older. Read the Media Release.

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