Assessment

Please fill out this short form. I will review your answers to determine if our program is suitable for your baby and will get back to you asap.

– Jennifer Duff, Founder

Parents' First Name

Parents' Last Name

City

Country

Post Code

Mobile Number(s)

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?

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?

While your child is learning a new sleep routine would you be most comfortable:

Remaining in the room to soothe your baby Leaving the room but checking in periodically Leaving the room and checking infrequently Using a pick up/put down method (each time the baby cries you pick up, cuddle, put down, repeat).

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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Routine & Feeding

Baby’s Personality

Sleep Training and assessing your parenting philosophy

Other

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