Pre-Consultation Form (Birth- 2)

Please fill out this form prior to our initial 1-1 consultation. This helps us dive into working together. All forms are kept under in a password protected email account and website, however due to the nature of the internet only share information you feel comfortable to share on here. I look forward to connecting with you on this journey.

Pre-Consultation Form (Birth-2)

First Name

Last Name

Phone

Country

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First and last name of child

Date of birth

Age of child

Age and sex of siblings

Other people living in the home

What would you like me to support you with in the consultation? What would you like most from me in our time together?

Which books by Aletha Solter have you read?

Can you describe your birth experience?

Do you use a pacifier or comforter?

Can you describe how you get your baby to sleep at night and your routine?

How often does your baby sleep in the day? (how, where, when and how long)

How often does your baby cry and when?

How do you feel about listening to your baby cry?

What sorts of stimulation do you provide for your baby? ie baby classes etc

Do you have support ie. family etc?

Was your baby born prematurely?

Is your baby breastfed or bottle fed?

Please write down your child's approx feed/meal times in 24 hours.

Is your child generally a good eater/feeder?

Please give a brief overview of your child's sleep and what methods (if any) you have tried to help them sleep. Please explain how sleep impacts you, your child and the rest of the family.

What are your goals regarding sleep?

Please fill out this sleep diary on a sheet. Time woke in morning: Time and length of naps in day: Time start for preparation for bed in evening: Time went to bed in evening: Who put him/her to bed: Time went to sleep: Times woke up: etc

Miscellaneous:   Give any other pertinent information about your child, yourself, your relationship with your child, your living situation, or your concerns:

I agree to the terms & conditions. See URL. https://www.flourishingchildhood.com/terms-conditions below.

Yes