Your full name
Your baby's name
Your preferred email for contact
Anything medical that should be known about
What is your baby's current daytime sleep schedule (if any)?
What does your baby's bedtime routine look like? Skip if you don't have one.
What type of sleep outfit does your baby sleep in?
What does your baby's sleeping arrangement look like? Please be specific.
How many hours does your baby sleep in a 24hr period. (Naps+ Night time sleep)?
Does your baby use a pacifier to sleep.
Yes, and I often have to reinsert it.
Yes, but it's not a prop. My baby doesn't mind or cry for it when it falls out.
No my baby does not use a pacifier.
Does your baby use any sleep props to fall asleep? or back to sleep during the night? Select all that apply.
Nursing to sleep
Bottle to sleep
Rocking to sleep
Bouncing, swaying, or any other movement
My baby does not use any props to fall asleep at bedtime or during the night
Which personality type best describes your baby. You may select more than one.
Quiet, mellow, laid back, doesn't mind change.
Cranky, fussy, rarely in a happy mood.
Clingy, anxious, often experiences separation anxiety.
Strong willed, stubborn, resists change.
Happy, playful, usually in great spirits.
Have you tried any other methods or programs?
What developmental milestones (if any) has your baby accomplished? Select all that apply
Holding head up when placed on belly
Rolling onto side
Rolling from belly to back
Rolling from back to belly
Sitting, but can't lay back down
Sitting, and knows how to lay back down
Standing, but can't sit back down
Standing, and knows how to sit back down
All of the above milestones
Which statement best describes how you feel about crying?
I don't mind hearing crying
I don't mind hearing some crying
I cannot hear any crying at all
Please provide in detail, any additional information that will help me understand what's going on with your baby's sleep troubles. If you have specific questions you can include them here too. If you forget to add something, no worries, you can always add additional information by emailing me.
Which package are you interested in, if any?
1 week of support
2 weeks of support
I'm not sure
Did a friend refer you? If yes, please tell me your friends name.
How did you hear about Erin Leetzow Sleep Consulting?
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