Dr. Brown's Medical Early Intervention Survey

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* 1. Contact Information

Name

Facility

State/Province

Country

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* 2. Please provide your email address if you would like to receive updates from Dr. Brown's Medical on webinars, products, and newsletters. Your information is safe with us and will never be provided to a third party.

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* 3. Discipline

SLP

Nurse

Other (please specify)

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* 4. What area(s) do you practice? Check all that apply.

Outpatient clinic

Home health

Hospital inpatient

Developmental f/u clinic

Telehealth

Rehab facility

Other (please specify)

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* 5. How many years of experience do you have?

0-5

6-10

11-15

More than 15

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* 6. With what percentage of your infant patient population do you address feeding issues?

0-25

26-50

51-75

76-100

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* 7. Please rank the following webinar topics on level of importance to you:

	Not needed	Low Need	Moderate Need	High Need
Tongue tie/tethered oral tissue	Tongue tie/tethered oral tissue Not needed	Tongue tie/tethered oral tissue Low Need	Tongue tie/tethered oral tissue Moderate Need	Tongue tie/tethered oral tissue High Need
Breastfeeding	Breastfeeding Not needed	Breastfeeding Low Need	Breastfeeding Moderate Need	Breastfeeding High Need
Oral motor evaluation	Oral motor evaluation Not needed	Oral motor evaluation Low Need	Oral motor evaluation Moderate Need	Oral motor evaluation High Need
GI disorders	GI disorders Not needed	GI disorders Low Need	GI disorders Moderate Need	GI disorders High Need
Report/goal writing	Report/goal writing Not needed	Report/goal writing Low Need	Report/goal writing Moderate Need	Report/goal writing High Need
Cleft lip/palate	Cleft lip/palate Not needed	Cleft lip/palate Low Need	Cleft lip/palate Moderate Need	Cleft lip/palate High Need
Feeding skills after NICU discharge	Feeding skills after NICU discharge Not needed	Feeding skills after NICU discharge Low Need	Feeding skills after NICU discharge Moderate Need	Feeding skills after NICU discharge High Need
Therapeutic interventions	Therapeutic interventions Not needed	Therapeutic interventions Low Need	Therapeutic interventions Moderate Need	Therapeutic interventions High Need
Transitioning off of feeding tubes	Transitioning off of feeding tubes Not needed	Transitioning off of feeding tubes Low Need	Transitioning off of feeding tubes Moderate Need	Transitioning off of feeding tubes High Need
Feeding with specific syndromes	Feeding with specific syndromes Not needed	Feeding with specific syndromes Low Need	Feeding with specific syndromes Moderate Need	Feeding with specific syndromes High Need
Feeding infants with trachs/vents	Feeding infants with trachs/vents Not needed	Feeding infants with trachs/vents Low Need	Feeding infants with trachs/vents Moderate Need	Feeding infants with trachs/vents High Need

Please list any other topics or speakers you feel would be valuable

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* 8. Would you or your clinic be interested in purchasing products in bulk (e.g. a case of bottles or nipples)?

Yes

We already currently purchase in bulk

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* 9. How do you clean your therapy feeding tools? Check all that apply.

Steam sanitizer bags in microwave

Dishwasher

Hand wash

Autoclave

n/a; we do not reuse any products

Other (please specify)

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* 10. What are the top 3 feeding tools you use in therapy? Please choose up to 3 from the below list.

NUK brush

Chewy tube

Maroon Spoon

Syringe

Z vibe

Arc Probes

Ps and Qs

Straws

Flexi cup

Reflo cup

Other (please specify)

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* 11. What therapy tools do you recommend most to parents to purchase? Please select up to 3 from the list below.

Nuk brush

Chewy tube

Maroon spoon

Syringe

Z vibe

Arc Probes

Ps and Qs

Straws

Flexi cup

Reflo cup

Other (please specify)

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* 12. What other products would you like to see developed for feeding therapy?

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* 13. Describe the frequency you use the following Dr. Brown's products:

	Was not aware of this product	Never	Rarely	Sometimes	Often	Very frequently
First Feeders	First Feeders Was not aware of this product	First Feeders Never	First Feeders Rarely	First Feeders Sometimes	First Feeders Often	First Feeders Very frequently
Slow flow nipples - Ultra Preemie, Preemie, or Newborn	Slow flow nipples - Ultra Preemie, Preemie, or Newborn Was not aware of this product	Slow flow nipples - Ultra Preemie, Preemie, or Newborn Never	Slow flow nipples - Ultra Preemie, Preemie, or Newborn Rarely	Slow flow nipples - Ultra Preemie, Preemie, or Newborn Sometimes	Slow flow nipples - Ultra Preemie, Preemie, or Newborn Often	Slow flow nipples - Ultra Preemie, Preemie, or Newborn Very frequently
Specialty Feeding System	Specialty Feeding System Was not aware of this product	Specialty Feeding System Never	Specialty Feeding System Rarely	Specialty Feeding System Sometimes	Specialty Feeding System Often	Specialty Feeding System Very frequently
Wide neck bottle system	Wide neck bottle system Was not aware of this product	Wide neck bottle system Never	Wide neck bottle system Rarely	Wide neck bottle system Sometimes	Wide neck bottle system Often	Wide neck bottle system Very frequently
Cleaning products	Cleaning products Was not aware of this product	Cleaning products Never	Cleaning products Rarely	Cleaning products Sometimes	Cleaning products Often	Cleaning products Very frequently
Teethers	Teethers Was not aware of this product	Teethers Never	Teethers Rarely	Teethers Sometimes	Teethers Often	Teethers Very frequently
Silicone Handles	Silicone Handles Was not aware of this product	Silicone Handles Never	Silicone Handles Rarely	Silicone Handles Sometimes	Silicone Handles Often	Silicone Handles Very frequently
Mixing Pitcher	Mixing Pitcher Was not aware of this product	Mixing Pitcher Never	Mixing Pitcher Rarely	Mixing Pitcher Sometimes	Mixing Pitcher Often	Mixing Pitcher Very frequently
Stage 1 pacifier	Stage 1 pacifier Was not aware of this product	Stage 1 pacifier Never	Stage 1 pacifier Rarely	Stage 1 pacifier Sometimes	Stage 1 pacifier Often	Stage 1 pacifier Very frequently
Preemie Pacifier	Preemie Pacifier Was not aware of this product	Preemie Pacifier Never	Preemie Pacifier Rarely	Preemie Pacifier Sometimes	Preemie Pacifier Often	Preemie Pacifier Very frequently
PreVent pacifier	PreVent pacifier Was not aware of this product	PreVent pacifier Never	PreVent pacifier Rarely	PreVent pacifier Sometimes	PreVent pacifier Often	PreVent pacifier Very frequently
Long Spatula spoon	Long Spatula spoon Was not aware of this product	Long Spatula spoon Never	Long Spatula spoon Rarely	Long Spatula spoon Sometimes	Long Spatula spoon Often	Long Spatula spoon Very frequently
Silicone feeder	Silicone feeder Was not aware of this product	Silicone feeder Never	Silicone feeder Rarely	Silicone feeder Sometimes	Silicone feeder Often	Silicone feeder Very frequently
Make a smash food masher	Make a smash food masher Was not aware of this product	Make a smash food masher Never	Make a smash food masher Rarely	Make a smash food masher Sometimes	Make a smash food masher Often	Make a smash food masher Very frequently

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* 14. How frequently do you recommend parents purchase/use Dr. Brown's feeding products?

Never

Rarely

Sometimes

Often

Very frequently

Never

Rarely

Sometimes

Often

Very frequently