Infant Sleep Intake Form

Collects the full history a sleep consultant needs before the first session: the baby's age and weight, room environment, bedtime routine, night wakings, feeds, temperament, childcare arrangements and what the family wants to change. With everything answered in advance, the call goes straight to the plan instead of the basics. Built for infant sleep consultants and early-childhood practices.

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Baby's name

Nombre

Apellido

Age of the baby in months

Baby's date of birth

Parent or guardian's name

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Phone number

How did you hear about our sleep consultancy?

If you chose "other", tell us here

Date of the last paediatrician visit

If not born at full term, how early?

Baby's current weight

Describe the sleep problems your baby is having

At night, does the baby sleep in your room or their own?

Describe the bedroom environment: temperature, blackout curtains, white noise and anything else

Describe your bedtime routine in detail

Where does your baby sleep during the day and at night? Cot, travel cot, pram, car seat and so on

In what position does your baby sleep most of the time?

Average number of wakings per night

How do you usually handle night wakings? Feeding, rocking, soothing with a dummy or something else

How many night feeds do you give and how many would you like to keep?

How is the baby put to sleep? Rocking, feeding or another way

What is the baby put down to sleep in?

Does your baby use a dummy or pacifier?

How much daylight does your baby get each day?

How much screen time does your baby have per day?

Is your baby breastfed, formula fed or both?

List your baby's usual feeding times

Has your baby developed predictable eating and sleeping patterns?

Does your baby have allergies, asthma, reflux or other medical conditions? Is your baby on any medication?

Do you think your baby has colic?

Does your baby snore, sweat or breathe with an open mouth while asleep?

Does your baby ever wake up from nightmares?

Describe your baby's temperament: easy-going, laid back, stubborn, independent, clingy, difficult or mixed

How much activity or floor time does your baby get each day?

How does your baby respond to new sensory experiences?

What time does your baby usually go to bed?

What time does your baby usually wake up in the morning?

Is your baby in daycare or regularly cared for by someone other than a parent, such as a sitter, nanny, relative or friend?

If your baby is in childcare, do they follow a sleep schedule different from the one at home? Please describe it

Describe the main goals you would like us to work on

Is there anything else we should take into account when building the sleep plan?

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