10 Do you now take any food or liquid .hro..gh a feeding tube?


(circle one)


No..............


. ... .... .. ...... .. 1


Yes.......................


11. Please circle the letter of the one description below that best describes the
 consistency or texture of the food you have been eating most often in the last week.


Circle one:

 A. Circle this one .i you are eating a full normal diet, which would include a wide
 variety of foods, including hard to chew items like steak, carrots, bread, salad,
 and popcorn.

 8. Circle this one if you are eating soft, easy to chew foods like casseroles, canned
 fruits, soft cooked vegetables, ground meat, or cream soups.

 C. Circle this one if you are eating food that is put through a blender or food
 processor or anything that is like pudding or pureed foods.

 D. Circle this one if you take most of your nutrition by tube, but sometimes eat ice
 cream, pudding, apple sauce, or other pleasure foods.

 E. Circle this one if you take all of your nourishment through a tube,