For clients

Your sleep questionnaire

Bought a package? Wonderful — tell us all about your little one's sleep so your consultant can prepare your personalised plan before you talk.

Sleep Questionnaire — 0 to 18 months

Select Package *

Which consultant would you like to work with? *

What is your child's name? *

Where do you live? *

Email *

Phone Number *

Parents name? *

How old is your child? *

How much does he / she weigh? *

Was your child premature? * Yes No

Did he / she have colic? * Yes No

Have there been any health issues or concerns? *

Is your child on any medication? If yes please specify *

Have you spoken to your doctor about your child’s sleep difficulties? *

What time does your child wake to start his/her day? *

What happens at this time? Are they given a bottle, breastfeed, start with solids, etc. *

What signals do you notice your child gives when he/she is tired? * Rubbing eyes Screaming and shouting (tantrum) Yawning Other

Other

What time of day does the first nap usually occur and where does it take place? *

How do you get your child to sleep for this first nap? *

How long does this nap last? * 10 Min 20 Min 45 Min 1 Hour 2 Hours 3 Hours Different every time

What time of day does the second nap occur? *

How does your child fall asleep for this nap? *

Is there a third or fourth nap during the day or early evening? * Yes No

What time do you start getting your son/daughter ready for bed? * 17:00 18:00 19:00 20:00 Later then 20:30

What do you do with your child when getting them ready for bed? (For example: bath, brush teeth, sing songs, read stories, play a game, etc.) *

What time does your child actually fall asleep at bedtime? *

How does your child fall asleep at this time and where? *

What happens during the night? (Best & worst case scenarios.) *

Have you read any books about infant sleep, and have you tried any suggestions from these books in the past? *

Was there a time when your child slept well and then things changed? *

Is your child in his/her own room? And in a crib or bed? * Own room Parents room Crib Own bed

There's an easy way

So many families suffer from a lack of sleep and think that's just how it should be. There is a solution — I lived this life, and I can help you.