Sleep Questionnaire

After completing the following comprehensive intake questionnaire below, you will be redirected to schedule a complimentary phone consultation with Dr. Davoudpour to discuss your specific goals and to find the right consultation option that best meets your family’s needs.

Name

First Name

Last Name

Phone

(###)

###

####

Baby's Age

Feeds (Click all that apply)

Breastmilk

Formula

Bottle Feeding

Feeding Schedule

To the best of your ability, please describe current feeding schedule (number of feeds, time of feeds, ounces per feed, average total ounces per 24 hour period)

Daytime Nap Schedule

Please describe baby's current nap hours on average over the past 5 days.

Nighttime Feeds and Sleep Hours

To the best of your ability, please describe baby's current nighttime feeds and sleep hours, on average over the past 5 days.

Other Children

Do you have other children? What are their ages? Where do they sleep?

Sleeping Arrangements

Where does baby sleep?

Which Option Are You Interested In?

We offer a few sleep training program options for babies and toddlers. Which option or package are you most interested in? Please select one of the following options from the drop-down menu.

Accommodations

Do you need ADA accommodations?

Yes

Please Explain

If you answered yes to the previous question, please explain.

How did you hear about Tiny Apricot?

Are you ready, willing, and able to accept some crying in order to help your baby learn to self-soothe and sleep independently?

Are you and all other caregivers aligned with your decision to sleep train your baby?

Please explain your baby’s current sleep challenges and why you reached out to us.