Parents/carer's name
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First Name
Last Name
Best Contact Number/Email
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Child's Name
First Name
Last Name
Child's age & Birth date
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Child's weight & birth weight
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Medical Conditions/Allergies?
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Does your Child snore or mouth breathe?
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Feeds per day, frequency & quantity
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Any issues with feeding/eating?
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Where does your child sleep?
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What does your child wear to sleep?
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Describe your baby’s sleep environment? (dark room? White noise? etc)
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Does your child have a Dummy or comforter:
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Dummy
Comforter
Both
Neither
Briefly describe your Baby’s day (wake up time, nap times and duration, bedtime etc)
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Describe your Child's night? Number of wakes/feeds?
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How does your baby get to sleep? (Dummy, rocking, feeding?) Is it the same day and night?
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Describe your child's sleep issue in detail & if you have tried anything to fix it?
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Briefly describe your parenting style - attachment parent, go with the flow, prefer set routine?
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Do you have any daily/weekly commitments that need to be factored in?
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Is your child working on any milestones at the moment?
rolling, crawling, standing, walking etc
What do you hope to achieve during our time together?
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Terms and Conditions
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