Fastener

Select Age* 0 1 2 3 4 5 6 7 8 9 10 11 12 13 older

Select Month* 0 1 2 3 4 5 6 7 8 9 10 11

Select Gender* Male Female

Enter Weight In Pounds*

Select Skin Tone* Light Medium Dark

How did you hear about us? Choose Option Pediatrician Dentist Satisfied customer Internet search Other

Left hand (both handaid devices will be made for the left hand.)
Both (a handaid device will be made for both the right hand and the left hand.)

Did you find kidshandaid.com using? Tablet Smartphone Laptop / Desktop

Please enter the full name of the physician or person who referred you to handaid*.

Is there anything that you feel would be important to us regarding your child's habit*

Does your child want to stop? Yes No

Palm resting on the chin
Palm pointed up in the air

What fingers does your child suck on? Check all that apply*. Index finger
Middle finger
Ring finger
Pinky
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