Client Intake Form -Helping your little ones get the rest they need-

What time does he/she wake up for the day?(required)

What time does he/she go to bed?(required)

What is your child's feeding schedule like?

Does he/she still get a feeding in the middle of the night?(required)

If so, what times do these typically occur?

How long does it take to go back to sleep after night feedings?

Does your child wake up at other times throughout the night?(required)

If so, are they specific times?

What do you do to put he/she back to sleep, and how long does it take?

Where does your child sleep? (Own room, with parents, with siblings, in a crib, family bed, etc.)(required)

Is there anything that helps your child fall asleep? (pacifier, rocking, lovey, etc.)

Does your child have any medical issues I should be aware of?

What is the general history of your child's sleep habits, since birth?