MyBaby Sleepology: Website

MyBaby Sleepology

We are excited to help you all get more sleep! Once we receive this intake form, we will follow up with program pricing. There is different pricing to work with Xan (The Founder), Senior Consultants and Team Members. You will be in great hands!
Parents' Names

First NameLast Name
Email address
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Program You'd like to Purchase:
What is Your Budget Range?
What Level Consultant Would you Like to Work With?
The more senior the consultant, the more expensive the program is. We will follow up with all pricing, regardless!
How did you hear about us? Please let us know the name of the friend, Facebook Group, influencer, etc!
Name of Child
Estimated Due Date
Actual Delivery Date
How will you prefer receiving info regarding your child's sleep?
What are your sleep goals?
What are your biggest challenges regarding your little one's sleep?
What does your child wear to bed? Sleep sack? Merlin?
What time are your child's nap(s) and how long per nap?
What time is bedtime?
What is your child's bedtime routine?
What time does your child wake up for the day?
How many hours of sleep does your little one get in a 24 hour period?
I place my child down

AwakeDrowsyAsleep
Does your child use any sleep props to go to sleep?

Feeding to sleepRocking/holding to sleepOtherNo props
Does your child use a pacifier?

Yes, but not as a sleep prop. It doesn't matter if it falls outYes, and I constantly have to reinsert itNo, my child doesn't use a pacifier
If your child wakes at night, how many times? How do you respond?
How many night feedings?
Any recent developmental milestone within the last 2 weeks? If so, what is it?
On a scale from 1-10 how skilled are they at this new milestone?
What is your cry tolerance?

HighMediumMedium/LowLow to No
Are you open to us tagging you on Instagram? (We will cross out names in emails and won't post photos without permission) If so, please include your Instagram handle
Are there any health issues we should be aware of?
Is there any additional information you'd like to share that would help me to understand your little one's sleep struggles?
Thank you for choosing our services! Please understand that we are a small business and group of moms striving to provide the best assistance possible. We kindly ask for your patience throughout the process as it is just that, a process! Our team is committed to helping you, and we take great care and pride in what we do.

...Now let's get you some sleep!

(And if you don't do so yet, you should follow us on Instagram @mybabysleepology!)
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