Infant Questionnaire

Please complete the form below

Baby's Name

First Name

Last Name

Mom's Name

First Name

Last Name

Dad's Name

First Name

Last Name

Baby's Age

Where does baby sleep?

If attempting to move to another sleep location, what is the nature of the new location? Where is it in the home, darkness level, sound machine, etc.?

What is your current night time/sleep schedule?

When does baby go to sleep, wake to feed and wake for the day?

What is baby’s demeanor when waking at night?

Talking? Squawking? Crying? Screaming?

What does your bedtime routine look like?

Does it vary from night to night or stay pretty consistent? Is baby awake or already asleep when placed into crib?

What does your nap time routine look like?

How many naps and for how long?

Are you nursing or bottle feeding?

Is baby eating when waking in the middle of the night? Is baby eating any solids?

What is your sleep/parenting philosophy when it comes to sleep training your baby?

How do you feel about some tears if it comes to that?

Describe for me your perfect night of sleep for your baby?

How many total hours? How many wakings?

What is your participation level from your husband/significant other?

Is he or she willing/able to help throughout the process?

Anything else?

Is there anything else you’d like to tell me about your baby, your family, your sleep environment or you goals?