Parents First and Last Name

Mailing address (just so we can send you love notes!)

Phone Number

Help us keep track of your activity in our Facebook Group.

What name (and email) is associated to your Facebook Account? 

Child's First and Last Name

How old is your child in months? (ie// 5m or 2y5m)

Child's Birthdate

Is your child over 18 months?

Is your baby swaddled?

What is your child's current weight?  Does your doctor have any weight concerns?

Does your child snore?

If selected other on the previous question, please specify or type in N/A.

If selected other on the previous question, please specify or type in N/A.

What does your child sleep in? (Sleeping bag, swaddle, blankets). Please also list the brand of the product you are using.

Which room does your child currently sleep in overnight and for naps?

Anything else you would like to mention about your babies sleep environment?

Does your child use a pacifier?

If bottle-fed, please list volumes and approximate # of feeds per day? or write N/A

Is your child on solids?

If on solids, how many times a day does child eat?

Please describe your child's development. Are they reaching age appropriate milestones? (ie. rolling, crawling, walking, separation anxiety etc).  Are there any concerns with their development?

If selected other on the previous question, please specify or type in N/A.

Does your child have any medical conditions or health concerns we should be aware of before starting this process?

Please describe in detail a typical DAY, from 7am to bedtime (include nap times, length of naps, activities, etc.).  The more information here, the better for us to get a good idea of your daytime routine/needs and current lifestyle.

(There will be a separate question about nights shortly)

How do you currently settle your child for naps?  How do you re-settle child when they wake from naps early?

Please describe in detail what a typical NIGHT currently looks like, from bedtime to 7am. 

Include information about what time bedtime is, how many wake ups, length of wake ups, your response, wake up time etc

How do you settle your child to sleep at bedtime?

How do you re-settle child when they wake up at night? What do you do when they wake?

Please describe exactly what the sleep problem you're experiencing is.

Please describe your ideal sleep situation? Where would your like your baby to sleep?  What would you like to work on in regards to your child's sleep?

What are your 3 main goals you hope to achieve once you have completed YDP?

Please describe your parenting style (Do you go with the flow or prefer a strict routine, would you consider yourself an attachment parent or follow any other parenting philosophy).

Please list from a scale of 1-10 (1 being not comfortable at all - 10 being very comfortable) how comfortable you are with crying? (understanding that we can't avoid crying all together)

Please provide any additional information that you might think will be relevant to your sleep situation that we have not already covered.

What is your level of commitment to changing your sleep situation?

Last, but not least - I understand that committing to the requirements of the program includes: attending calls, filling out sleep logs, reaching out for support and following the plan we come up with together.