Chewing Assessment Form
Evaluate chewing function and related observations using this general-use assessment form.
Overall chewing ability
*
1
2
3
4
5
Chewing side preference
*
Left
Right
No preference
Observed difficulties during chewing
Food spillage
Prolonged chewing time
Fatigue
Coughing
None observed
Other
Texture tolerance assessment
*
Rows
Not tolerated
Partially tolerated
Well tolerated
Soft foods
1
2
3
Regular foods
4
5
6
Crunchy foods
7
8
9
Mixed textures
10
11
12
Jaw movement observed during chewing
*
Smooth and coordinated
Uncoordinated
Limited movement
Chewing speed
Fast
Average
Slow
Signs of discomfort or pain while chewing
None
Mild
Moderate
Severe
Drooling during chewing
Never
Occasionally
Frequently
Overall satisfaction with chewing function
1
2
3
4
5
Additional comments or observations
Submit Assessment
Should be Empty: