Toddler, Preschool, & School-Age Sleep Questionnaire

I’d like to ask you to take a few minutes to answer some questions about your child’s sleep habits and more before we have our consultation. This will help me prepare for our meeting and will let us make the best use of our time together. Please note, that some questions may not apply to your family and if that is the case, feel free to skip over those.

Please include as much information as possible; this will help me learn about your child and family and all the factors that could affect sleep. Please return this as quickly as possible so I can begin working on your child’s sleep program.

Thank you for putting your trust in me to help your child to develop healthy sleep habits. 

What size t-shirt do you wear? (you'll thank me later 😉 )
Medical Questions
Dietary Questions
Personality and Behavioral Questions
Activities and Interests Questions

During Phase 1, we are going to be working on creating and enforcing boundaries around your child’s challenging Daytime behaviors. We are looking to start with “easier” behaviors, which will gain you confidence as your child starts to respect your boundaries. You can build up to more challenging behaviors, which will become easier as your child begins respecting you and your boundaries. Together, we will decide on what behaviors we will start with. Some examples include: Brushing teeth, putting on shoes, getting dressed, holding hands while outside/in public, throwing food, eating a meal, getting in the car....etc.

Sleep Questions
Daytime Schedule
Is your child cared for by someone other than you?
Scheduling Questions
Other Questions