Parent Testimonial Questionnaire

Nutricia North America, the manufacturer of Neocate Infant formula, is seeking parents of children taking Neocate for testimonials to be used primarily on the Neocate Web site. We know that having a child with a condition like milk protein allergy, eosinophilic esophagitis or gastroesophageal reflux is an extremely difficult experience. We hope that, by providing relief of your child’s painful symptoms, Neocate has helped make it a little bit easier.

We hope that you will help us raise awareness of these conditions and their treatment by sharing your story with others. We plan to gather numerous completed questionnaire’s (please see attached) from parents like you and turn several into a narrative format that will be posted on the Neocate Web site, our Food Allergy Living blog, Facebook page and other public education materials. We really appreciate “before Neocate” and “after Neocate” photos if you have them, as it really helps other parents see the difference the correct diagnosis and treatment can make in a child’s life.

We thank you in advance for your help. Should you have any questions about the questionnaire, please contact a Nutrition Specialist at 1-800-365-7354. Please fax completed form to 301-795-2302 or e-mail to giateam@shsna.com.
*Required Fields
 
*Your Name:
Your Spouse/Partner's Name:
Your Child's Name:
Age of Child:
Child's age when diagnosed:
*Address:
*Home Phone:
Work/Mobile Phone:
*E-mail Address:
Best time to contact you:
Has your child been diagnosed with:
  
Which Neocate product did you first use?
Please describe your child’s symptoms prior to using Neocate. How old was he/she when he/she first experienced them? Did they change over time? Etc.
How did these symptoms affect your child's physical and emotional health? What kind of an effect did they have on you and the rest of your family?
Please describe the steps taken to get the correct diagnosis (e.g., doctor visits, referrals, emergency room visits, tests). How much time did it take from the onset of symptoms to a correct diagnosis? Did the symptoms get worse during this time?
What were some of the treatments you tried (before Neocate)? How effective were they?
How did you hear about Neocate? (e.g., from your doctor, other parents, online resources) Did you find it effective? How long did it take for Neocate to relieve your child's symptoms?
Please share your success story with using Neocate
Are you willing to have your photograph taken?
Are you willing to have your child's photograph taken or send your child's picture?
Are you willing to be video taped?
Are you willing to have your child video taped?
Would you be willing to talk to the media about your experience?
Success Stories

Sawyer was only one month old when she began to suffer from vomiting and skin rashes. Thanks to Neocate, Sawyer's rash has gone away and she is now a happy and healthy baby girl.

Click here to read more.

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Food Allergy Living

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