Special Needs Sleep Program
Hi there,

Thanks so much for your interest in the Special Needs Sleep Program! I am looking forward to helping you and your family get the best night's sleep possible.

Please be so kind as to fill out this application to the best of your abilities with regards to your child's sleep. As soon as this form is complete, you'll get an email to schedule your discovery call with me. Then we can talk about how the Special Needs Sleep Program will help you and your family!
Email address *
Your Name *
Your child's name *
How old is your child? *
What is your child's diagnosis? *
Was your child born full term, or prematurely? *
What is your child's current weight? (It doesn't have to be exact) *
Does your child currently have issues gaining weight, or was this an issue in the past? *
Is your child eating well? *
Does your child have any major health concerns or issues now, or in the past? (Examples of this are heart/lung issues, chronic constipation, etc.) *
When sleeping at night, do your child doing any of the following? *
Required
Is your child currently on any medication? *
Does your child take melatonin to sleep? *
Right now, what does a typical night look like for your child? This can include how long it takes them to sleep, how many nighttime wake ups, if you help your child to get to sleep. Feel free to give details here, the more the better! *
How do you put your child to sleep each night? What's your usual routine? *
Where does your child sleep usually? *
If your child naps, how are naps going during the day?
In an ideal situation, what would you like your child's sleep to look like? What would be your top 3 goals? Be specific - I want to make sure that the Special Needs Sleep Program is going to help you achieve these :) *
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