Sleep Assessment

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Free Sleep Screening

If you’re experiencing sleep issues and you’re unsure if hiring a sleep consultant is the answer for your family, fill out this short assessment and I’ll be in touch once I receive it! In the meantime, you can check out my social media for reviews from parents just like you. @heavensentsleep on Facebook or Instagram.

15Questions

1
Your Name & Contact Information* This field is required.
First & Last Name
Email Address
2
Child’s Information* This field is required.
Child's Name
Child's Date of Birth
Was your child premature?
3
Regarding your child's daily routine / schedule:* This field is required.
We have no routine / schedule & need help creating one
We have a loose routine in place, but it's not really working for our family
I don't even know what an age appropriate routine / schedule would look like
We have a routine in place and it seems to work well
Other
4
How many naps a day does your child take?* This field is required.
None
1-2
3-4
more than 4
Other
5
How does your child fall asleep for bedtime and/or naps?* This field is required.
on their own, from mostly awake
on their own, but mostly drowsy
rock / bounce to sleep
feed to sleep
cosleeping
Other
6
Where does your child currently sleep?* This field is required.
own room / crib or bed
parent's room / crib or own sleeping space
parent's room / parent's bed
Other
7
What issues are you currently experiencing with your child's sleep?* This field is required.(you can pick more than one)
waking multiple times a night
difficulty getting child to sleep / taking hours at bedtime to fall asleep
short naps
currently co-sleeping and don't want to anymore
no daily schedule / structure
waking too early in the morning
was a good sleeper and now they're not
bedtime is too late
falls asleep easily but wakes immediately when I lay him/her down
will only nurse / feed to sleep
takes a pacifier and needs it replaced multiple times at night
Other
8
Have you attempted sleep training before?* This field is required.
yes, epic fail
yes, it sort of worked
yes, it worked for a while
haven't tried yet
too overwhelmed to try
Other
9
If you answered yes to the previous question, what method did you use?* This field is required.If you answered no, just type n/a
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10
What would you like to change about your current situation?* This field is required.
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11
Any other information I need to know? Medical issues? Parenting style? Child's temperament? This is your space to tell me everything!* This field is required.
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12
How ready are you to commit to making the necessary changes to help your child get more sleep?* This field is required.
Should’ve started yesterday!
Let’s get this show on the road!
Price is holding me back
I’m ready but my spouse isn’t
Circumstances are holding us back
Maybe next month
13
Have you reviewed my different package options?* This field is required.
YESNO
14
If you have, is there an option that would fit your family best? If not, would you like more information?* This field is required.
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15
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