1 Hour Call: Intake Form

Why did you decide to contact me?

What do you hope to achieve from this call?

Describe your child’s temperament generally. Do they consistently become fussy or grumpy at certain times of day?

Who handles night wakings? And how do you soothe/get your child back to sleep?

Does your child generally wake, nap, and go to bed at the relatively same time? Please describe.

Any locations where your child sleeps during the day (examples: crib, floor mattress, stroller, car seat, Pack n’ Play, swing, couch, carrier, etc.)

What does your child’s sleep arrangement look like? Is their room dark, what's the temperature like, is their door closed, etc.

Describe their bedtime routine.

Are you present when your child falls asleep? If so, what soothing techniques do you use with your child?

Please describe their childcare situation. What time are they there during the day? How many days a week? Do they nap there? Etc.

Do you have any concerns with any sleep training methods?

Is there anything else related to your child, the home dynamic, or your child’s sleep that I should be aware of?

Does your child have any neurodivergent disorders?

Does your child have any sensory sensitivities? If so, please elaborate.

This form must be filled out at least 24 hours prior to your scheduled consultation call. Book online prior to filling out the form.