Pisces Innovation | Fit Check

It takes about five minutes, and is divided into four sections. Upon completion, you will be contacted by one of our customer representatives.

Who

Eating

Safety

Environment

Submit

Section 1 – Who is completing this?

First Name *

Last Name *

Email *

Phone Number *

I am completing this as: *

End user Family member Caregiver Clinician ATP Facility representative School representative Foundation or funding source Other

Who is the product for? *

Myself Family member Patient or client Resident Student Veteran Other

Where is the intended user located?

Is the user working with a clinician, OT, SLP, ATP, VA clinician, or care team? *

Yes No Not sure

Optional: Clinician / care team details

Name

Role

Organization

May we contact your clinician?

Yes No

Section 2 – Goal and current eating situation

What condition or presentation is related to the eating difficulty?

How does the user currently eat? (tick all that apply)

Fully fed by another person Partial assistance Adaptive utensils Arm support Manual feeding device Tube feeding plus some oral intake Not currently eating by mouth Other

What best describes the current challenge? (tick all that apply)

Limited arm or hand movement Weakness Tremor or ataxia Spasticity Fatigue Difficulty bringing utensil to mouth Caregiver currently feeds user User can self-feed but not a full meal Other

What are you hoping to achieve? (tick all that apply)

Eat more independently Drink more independently Both Reduce caregiver feeding time Improve mealtime dignity Support school or facility participation Evaluate for funding Other

Section 3 – Basic suitability and safety

Can the user safely chew and swallow food by mouth? *

Yes No Not sure Yes, with modified texture Yes, with supervision

Are there any current eating or swallowing safety considerations we should be aware of (e.g. regular choking, coughing during meals, aspiration concerns)? *

No Yes Not sure

When a spoon is brought to the user's mouth, are they able to close their lips around the spoon and remove food comfortably? *

Yes No Not sure Sometimes Depends on food texture Depends on fatigue or positioning

With their usual seating or supports, is the user able to sit in a comfortable, upright eating position with their head and neck well supported? *

Yes No Not sure Yes, with support Positioning is currently difficult

Does the user experience head movements that may affect their ability to take food from a consistent spoon position? *

No Mild Moderate Significant Not sure

Is the user familiar with any of the following device control methods? (tick all that apply)

Touchscreen Hand switch Head switch Foot switch Voice Caregiver assistance Not sure

Section 4 – Environment, support, and next step

Where would the device be used most often? *

Home dining table Wheelchair tray Hospital or facility School Multiple locations Not sure

Who can help with setup, food preparation, positioning, and cleaning if needed? *

User independently Family caregiver Paid caregiver Facility staff Clinician during trial No one available Not sure

Review & Submit

You have completed all four sections. Please read and accept the consent below, then submit your Fit Check.

I understand this Fit Check helps determine product suitability and next steps. It is not a medical evaluation or a substitute for advice from my healthcare provider.

Fit Check for Neater Eater Robotic Dining System