Questionnaire

Please fill out the questionnaire below to help us better understand your child's sleep needs and create a customized plan.

Let's Chat

First Name

Last Name

Child's Name

Child's Age (in weeks, months or years)

What is your child's current sleep environment? Please include where they sleep, if you use black out curtains and/or white noise.

What is your child's current morning wake-up time?

Does your child need to be awake at a specific time each morning? If so, what time?

What is your child's current bed time?

What is the ideal bedtime you have for your child?

Have you implemented a bedtime routine? If so, please describe it.

What is your child's current nap schedule? Provide time of day and average duration of naps

Are there any scheduling conflicts I should be aware of when giving recommended nap times?

How long does it take for your child to fall asleep?

Can your child fall asleep unassisted? If no, how do you get your child to fall asleep?

How many night wakings is your child having? How do you respond?

How many times is your child eating during the night?

How many night feedings do you wish to keep, if any?

Does your child use a pacifier/swaddle/comfort blanket?

Is your child in dayare outside of the home? If yes, how many days/week and please describe their sleep environment and schedule when there.

Please describe the issues you are currently facing with your child's sleep habits and include any methods you have used to attempt to correct them.

What are your sleep goals for your child?

Are there any sleep training methods that you agree or disagree with?

Are there any medical issues that I should be aware of?

How did you hear about me?

Please include any other information that you would like for me to know.

Thanks for submitting!

Aubrie, San Diego

Kari is amazing with sleep training! I will use her every time. She helped me sleep train a very attached 7 month old in two days. Then sleep train again several months later after a major sleep regression. She was there for me with tips for a very tired mama who was desperate. She is encouraging and her method really works!