Name
First Name
Last Name
Email
example@example.com
Child's Name
Your location (state and time zone)
Are there any suspected or diagnosed medical, neurodivergent, or physical factors that I should be aware of? (Such as: chronic constipation, stool withholding, chronic UTIs, daily medications, conditions like ADHD or autism, or sensory preferences and sensitivities).
Which package are you interested in?
The Potty Kickstart
The Potty Essentials
The Potty Success
I'm not sure yet
Which of the following signs of potty training readiness is your child showing?
Staying dry 1-2 hours
Uses bathroom lingo (pee pee, poo poo, potty etc)
Is interested in the potty or toilet
Is interested when others use the bathroom
Can pull up and pull down own pants
Tells you when is peeing/pooping
When it comes to potty training pace, which best fits your child and family?
We’d like an intensive ‘quick start’ plan (around 3-5 days, high focus and consistency )
We’d prefer a gradual approach (over 2–3 weeks, slower and more flexible)
Not sure yet—happy to discuss your recommendation
Other
What have your tried in terms of potty training?
Do you have any concerns about potty training?
Please explain in detail
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Child's Age
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