The Nap Whisperer New Client Form

I am so excited to learn more about your family & support your baby's sleep! The below questions will help me better understand your baby's sleep patterns and needs. Let me know if you have questions.

Does baby have any medical/developmental issues diagnosed

Yes

Is baby bottle fed, breast fed or both

Bottle fed

Breast fed

Both

Is baby on a schedule

Strict schedule

Loose schedule

None

How many times a night does your baby currently wake up

1x a night

2x a night

3x a night

4x+ a night

How comfortable are you with your baby crying (if you know they are fed, have a clean diaper, and room is a comfortable temperature)

Comfortable

Not very comfortable

Not comfortable at all

Do you plan to go back to work or are currently working

Yes

Maybe

What is your goal amount of wake ups for baby a night

0 wake ups

1 wake up

2 wake ups