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Preliminary Questionnaire

Please take a few minutes and answer some questions about your child's sleep habits to help me prepare for our meeting. It will allow us to make the most of our time together.

About Your Baby:

What is your baby's name & pronouns?

Your baby's date of birth:

Names of parents, other caregivers and siblings (& prounouns)

Please provide your mailing address:

Please provide your phone number:

Was Your Baby Premature?

Have there been any health issues or concerns?

Have you spoken to your doctor about your baby's sleep difficulties?

Is your baby on any medication that I should be aware of

Tell me about your baby's personality and temperament! What do they love and what do they dislike?

Sleep Environment & Sleep

Where does your baby sleep (bed, co sleep, bassinet, pack n' play, crib)?

Describe your baby's sleep environment (white noise? dark? night light? clock?):

What time does your baby wake up to start their day?

What happens at this time? Are they given a bottle, breastfed, solids?

What signals do you notice your baby gives you when they are tired?

What time are naps?

How do you get your baby to sleep for their naps?

How long do these naps last?

What time do you start getting your baby ready for bed?

Describe their bedtime routine & how long is it? (ex: bath, pajamas, brush teeth, sing...etc)

How does your baby fall asleep at bedtime?

What time does your baby actually fall asleep at bedtime?

What happens during the night? Best and worst case scenarios.

Would your baby be more calm or irritated if you were with them during the gentle sleep changes we are making?

Your Baby's Day to Day

Describe your baby's daily eating/feeding schedule:

Describe your baby's day to day schedule (daycare, school, at home?):

Was there a time when your baby slept well and when did things change?

About you

What are your top sleep goals for your family?

Are there any schedule challenges with getting your baby to bed on time?

Do you have any concerns or worries about getting your baby to sleep well?

Is everyone in the household committed to seeing your baby sleep well and on their own?

Tell me about your parenting style:

Is there anything else you would like to share with me before we meet?

Have you read any books about infant/baby sleep and tried their recommendations?

Are there specific topics you wish to discuss during our time together? Please share:

How did you hear about Plume Sleep Solutions? Please let me know if you were referred!

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