The Sleep Dept Intake Form
Erika Lamour | Infant Sleep Consultant
e: erika@thesleepdept.com
m: 0422 969 946
w: www.thesleepdept.com
Email address *
Name *
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Phone Number *
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What is your baby's name? *
Your answer
How old is your baby?
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Your baby's birthday *
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How much does your baby weigh? *
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Have you ever had any health issues with your baby? If so, are they under control (medication etc)? *
Your answer
What is your baby's temperament? Fussy, Calm, Spirited etc *
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What is your child's sleep issue? *
Your answer
What time does your baby go to bed at night? *
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Where does your baby sleep? (bassinet, cot, mum and dad's bed) *
Your answer
Is your baby rolling? If so, does this affect their sleep at night? *
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Is your baby swaddled or in a sleeping bag? *
Your answer
Describe your baby's sleeping space (how dark is the room, is there any white noise, what is in the cot etc) *
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Do you have a bedtime routine, and if so, what does it look like and how long does it last? *
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Is your baby awake once put down for the night? What happens when your baby wakes in the middle of the night? (whinge/cry/scream) How long are they left for before someone responds? And how are they resettled? *
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Does bub have any sleep associations? (being fed to sleep, rocked, needs you there, music, mobile, dummy, pram, car, bouncer, swing etc) *
Your answer
Does your baby have a small comforter or small soft toy that they always have at sleep times? *
Your answer
What techniques have you tried yourself to get your baby to sleep through? How did you go with these? *
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Is your baby eating solids, if so how many times a day? *
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How many times a day does your baby nap? How long for each nap? Is this done in their own sleeping space? *
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On average, what are your baby's awake timesbetween each nap? *
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Have you got any holidays or big moves coming up? *
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Is everyone in the family on the same page? *
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What are your sleeping goals?
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Is there anything else I should know? *
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How did you find out about The Sleep Dept.? *
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Would you like to be added to our Newsletter? *
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