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Contact Information

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Do not enter your information in all capital letters, unless you are specifically instructed to do so.

Please fully spell out the State or Province. Please do not abbreviate.

Name*
First Last

Job Title*

Discipline*

Address

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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City*
Please fill in your City. Spell out the entire name (no abbreviations).

Do not use all caps.

If your location does not have a City, please fill in this field with the ALL (use all caps please).

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State/Province*
Please fill in your State/Province.

Spell out the entire name (no abbreviations). Do not use all caps.

Enter the word "ALL" if your location does not have a State or Province

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ZIP / Postal Code*

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Country*
Country

Phone Number*

Email*

Website

SOS Approach to Feeding Conference Details

Completion Date*
Please select the date that you completed the SOS Basic Conference (last day of the conference).
MM slash DD slash YYYY

City and Country of Conference Attended*
If you attended a virtual conference, please write Live Stream Conference-Online - Month Year (Example: Live Stream Conference - June 2020)

SOS Certificate of Attendance*
Please upload your SOS Certificate of Attendance. (If you do not have a copy of your certificate of attendance, please request a copy from the host where you attended the conference.)
Max. file size: 50 MB.

Advanced Workshops

Have you completed any SOS Advanced Workshops?*

Yes

No

SOS Advanced Workshops
Please select all of the SOS Advanced Workshops that you have completed.
Children with Gastroesophageal Reflux
Feeding the 6-16 Month Old Child
Feeding the Child on the Autism Spectrum
Food Scientist Model: SOS Approach to Feeding Adaptation for the School Aged Child
Food Tolerance Decision Making
Helping Children Achieve and Maintain the Just Right Arousal Space for Learning
Helping Children Transition Off Supplemental Tube Feedings
Lunchables to Lunch and Variety to Volume
Parents as Partners: Helping the "Challenging" Family
Setting Up A Feeding Clinic As A Business
Tools in Your Pantry: Effectively Using the New Oral-Motor Steps to Eating
Working with Children with Severe Developmental Impairments

SOS Advanced Workshop - Certificate(s) Upload
Please upload your certificate(s) of completion for SOS Advanced Workshops.
Max. file size: 50 MB.

SOS Mentorship

Have you completed the 12-week, online SOS Mentorship course?*

Yes

No

SOS Mentorship - Certificate Upload
Please upload your certificate of completion for SOS Mentorship.
Max. file size: 50 MB.

SOS Certified Therapist

Have you completed the 12-week, online SOS Certification Course?*
Please note - SOS Certification is not the same as attending one of the basic training conferences. To be an SOS Certified, you would have completed the 12-week, online SOS Certification Course.

Yes

No

SOS Certification - Certificate Upload
Please upload your certificate of completion for SOS Certification.
Max. file size: 50 MB.

Professional Experience & Focus

Primary Work Setting*

What is the primary population of your feeding therapy services?*
Autism Spectrum Disorders
Visually Impaired
Children w/ multiple medical complications
Developmental delays
Neurological/motor impairments
Picky/restricted/selective/fussy eaters
Sensory Processing Disorders
School-aged children
Other

How many years of pediatric work experience do you have?*

0-1

1-3

4-6

7-9

10+

How many years of feeding therapy experience do you have?*

0-1

1-3

4-6

7-9

10+

What percentage of your caseload is Feeding Clients?*

0%-25%

25%-50%

50%-75%

75%-100%

At what level do you implement the SOS philosophy?*

Fully implement

Implemented fully to best of my ability-modifications due to site's physical constraints

Use of some SOS combined w/different approaches

How many years have you been implementing the SOS philosophies into your practice?*

0-1

1-2

3-4

5-6

7+

Insurance
HMO
Medicaid
POS/PPO
Other

Optional: Customize your referral listing
Please provide a short description of your services/practice/experience to be displayed next to your contact information. (max - 150 characters.)

By checking the box below, I agree that the information I have provided is correct to the best of my knowledge.*
Furthermore, I agree that my name and contact details (City, State/Province and Country) will be placed on a list for families and health providers looking for health care professionals implementing the SOS Approach to Feeding program. Please note: Toomey & Associates, Inc. reserves the right to decline or remove contacts from this list without notice. Toomey & Associates, Inc. will not sell or provide this information to any third-party person and/or organization.
I agree to the terms.

Would you like sign up for our email list?*
Sign up today and receive information, resources and practical strategies on feeding support using the SOS Approach to Feeding. Emails are sent approximately once per month. Unsubscribe at any time.
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Phone
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Contact Information

Address

SOS Approach to Feeding Conference Details

Advanced Workshops

SOS Mentorship

SOS Certified Therapist

Professional Experience & Focus

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