Neocate

Parent Testimonial Questionnaire *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: Milk allergy Eosinophilic esophagitis Gastroesophageal Reflux Atopic Dermatitis Other    Which Neocate product did you first use? Neocate Infant with DHA and ARA Neocate Infant Neocate One + Neocate Junior EO28 Splash Pepdite Junior Duocal Polycal Phlexy-Vits Flavor Packet Please describe your child's symptoms. How old was he/she when 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? Yes No Are you willing to have your child's photograph taken or send your child's picture? Yes No Are you willing to be video taped? Yes No Are you willing to have your child video taped? Yes No Would you be willing to talk to the media about your experience? Yes No

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Last update: 05/01/2008
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