Intake Form

Name*

First NameLast Name

Baby's Name*

Please provide the email you wish to use to communicate.*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please provide a phone number *

Baby's Age (If your baby was born prematurely please add their adjusted age)*

Baby's Weight*

What is your baby's schedule like? Be as detailed as possible.*

Do you have a bedtime routine? If so, please describe it.*

What type of outfit does your baby wear to sleep?*

What is your baby's sleep environment like? Please describe in detail*

How many hours does your baby sleep in a 24 hour period? Naps and nighttime *

Does your baby use a pacifier to sleep?*

Yes, and I often have to re-insert itYes, but not as a sleep prop.No, my baby does not use a pacifierOther

Does your baby have an overnight feeding?*

YesNoSometimes

If you answered "YES", how many overnight feedings?

How many ounces of milk does your baby get in a 24 hour period? *

Is your baby or toddler formula fed, breastfed or both?*

Does your baby eat solids? If so how many times a day?*

Does your baby use any sleep props to fall asleep? Or to fall back sleep?*

Which personality type describes your baby? You may choose more than one*

Quiet, mellow, laid back, does not mind changeCranky, fussy, rarely in a happy moodClingy, anxious, has separation anxietyStrong willed, stubborn, resists changeHappy, playful, usually in a good moodOther

Have you tried any sleep training or other programs?*

Please choose the developmental milestones your baby has reached so far?*

How do you feel about hearing your baby cry?*

I do not mind hearing cryingI do not mind hearing some cryingI cannot hear any crying at allOther

Please describe in detail what any additional information that could help me understand what your babies sleeping issues are like. What is your goal with "sleep training"? Let any questions or doubts here or send me an email.

How did you hear about Baby Sleeps Best?*

What type of service are interested in*

Virtual ConsultationIn-home consultationText support with an expertPhone support with an expert

TERMS AND CONDITIONS

BY SIGNING BELLOW YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

MEDICAL DISCLAIMER: The information/advise provided during this consultation is not medical advise. You are not establishing a medical professional/patient relationship. The advise is for informational purposes only and it is intended for use with healthy children with common sleep issues that are unrelated to medical conditions. The information provided is not intended nor is implied to be a substitute for professional medical advise. Always seek the advice of your physician with any questions you might have regarding a medical condition or the health and welfare of your baby.

PEDIATRICIAN APPROVAL: You agree to consult and get approval from your pediatrician before following the advice or using the techniques offered during this consultation.

LEGAL NOTICE: In no event will Martha Carolina Parra or Baby Sleeps Best be liable to you for any claims, losses, injury or damages as a result of reliance on the information provided. All though all attempts have been made to verify the information provided is accurate, Martha Carolina Parra does not assume responsibility for errors, omissions, or contrary interpretation of the subject matter within the consultation. Reliance on any advice given by Martha Carolina Parra is solely at your own risk.

REFUND POLICY: Due to the amount of time, effort, and commitment provided within a consultation, refunds are not possible once payment is submitted.

COPYRIGHT NOTICE: The information provided within the consultation may not be reproduced, republished, or transmitted in any form or by any means mechanical or electronic, including photocopying and recording, or by any information storage and retrieval system, without permission.

All information supplied by Martha Carolina Parra either verbally, written or implied remains the property of Baby Sleeps best at all times. Written permission is required to reproduce, record, publish or advise verbally any details of the provided sleep plan, E-guides, charts, notes, advice offered or consultation transcript or summary in any format whatsoever. This includes but is not limited to any details published on any blogs, forums, or similar boards. Any information supplied by Martha Carolina Parra/Baby Sleeps best is confidential. Any passing of any information to anyone is strictly forbidden and subject to international copyright laws.

Please check the box and sign the box*

I have read and agree to the term and conditions

Signature