Parents' First Name
Parents' Last Name
City
Country
Post Code
Mobile Number(s)
Email
Baby's Name
Baby's D.O.B & age in months
Was baby born on due date. If not how many days early or late?
Baby's Birth Weight
Baby's Current Weight
Routine & Feeding
What is your baby’s current 24hr routine (milk, solids, naps, sleep/wake times)?
What is your current settling technique?
Where does your baby sleep? (own room, bassinet, cot, co-sleeping)?
Explain the sleep issues you are having?
Baby’s Personality
Describe your baby’s temperament (easy, slow to warm up, difficult, mixed).
Any known allergies? Food intolerances in the family? Eczema? Asthma? History of vomiting/choking when upset? Medical issues? If so, is your baby on any medication?
Sleep Training and assessing your parenting philosophy
Have you tried any sleep training methods or visited sleep clinics? Pls explain the experience.
How do you feel about allowing your baby to cry?
Cannot tolerate even a bit
It's ok for a few minutes
Not a problem when necessary
Making any kind of changes to a child’s routine and comfort zones often comes with a bit of temporary upset. How long do you think you would be comfortable letting your baby cry while adjusting to a new routine?
Not at all
1 minute
3 minutes
5 minutes
10 minutes
20 minutes
30 minutes
As long as necessary
Other
Describe what else is going on in your household that might affect your child: parent’s arguments, new nanny, new baby, a job change, a move, an illness or death in the family. Please mention if your child is planning to start daycare soon or if you are planning a holiday/nights away in the next two - three weeks?
What are your goals/what would you like to achieve?
How did you hear about us?
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