Preliminary Questionnaire | The Gentle Sleep Specialist

I'd like to ask you take a few minutes to answer some questions about your child's sleep habits before we talk in person. This will help me prepare for our meeting, and will let us make the best use of our time together. There are quite a few questions, but almost all of them can be answered in just a sentence or two, so please don't be intimidated!

Once you have worked through the questions below, simply submit and follow the links to my Terms and Conditions and my 'Travel Tips' information sheet. If you could get it back to me at least two days before we are scheduled to meet, I would appreciate it.

Thanks, Tara Mitchell

Your Details

Parent/s name/s*

Email*

Phone*

Address

Street Address City State / Province / Region ZIP / Postal Code Country

How did you hear about The Gentle Sleep Specialist?*

In a couple of words, we'd love to how you found us? Google, Instagram, Facebook, Friend etc

About Your Child

Your child's name*

Please complete one form for each child.

Date of Birth*

Are you breast feeding or bottle feeding?*

Breast
Bottle

If bottle feeding, how much?

Was your child premature?*

Yes
No

If yes, by how much?

Does your child have colic?*

Yes
No

Has your child had any other health issues or concerns?*

Yes
No

If yes, please give brief details.

Is your child on any medication?*

Yes
No

Please provide details of the medication.

About Your Child's Sleep

Have you spoken to a Doctor about your child's sleeping difficulties?*

Yes
No

What was the outcome?

Does your child use a dummy?*

Yes
No

What time does your child wake to start their day?*

Describe what happens at this time. Are they breastfed, given a bottle, start with solids etc?

What signals to you notice your child gives when he or she is tired?

What time of the day does the first nap usually occur and where does it take place?

How do you get your child to sleep for this first nap?

What time of the day does the second nap occur and where does it take place?

How do you get your child to sleep for the second nap?

Is there third or fourth nap taking place in the day or evening? If so, please give details.

What time do you start getting your child ready for bed?

What do you do when getting them ready for bed?

What time does your child actually fall asleep at bedtime?

How does your child fall asleep at this time?

What happens during the night? (Best AND worst case scenarios)

Have you read any books about infant sleep?

Yes
No

If so, have you tried any suggestions from these books in the past?

Is there anything else you would like to share with me that you think I should know before we meet?

Terms and Conditions.

*You need to scroll to the bottom of the Terms and Conditions before accepting them - please ensure you read them. Thank you.

Terms of Service*

The Gentle Sleep Specialist
The information provided by The Gentle Sleep Specialist is for informational purposes only and is intended for use to assist with common early childhood sleep issues that are wholly unrelated to medical conditions. Information provided either via The Gentle Sleep Specialist website, Facebook page, through written correspondence, or provided verbally is not intended to be a substitute for medical advice or treatment. Always seek the advice of your doctor or other qualified health practitioner regarding any matters that may require medical attention or diagnosis, and before following the advice and using the techniques described from The
Gentle Sleep Specialist and Sleep Sense Program. Reliance on any information provided by The Gentle Sleep Specialist is solely at your own risk.
Exclusion/Limitation of Liability
The Gentle Sleep Specialist does not make any representations or warranties, express or implied, regarding consulting services provided. In no event will The Gentle Sleep Specialist be liable for any loss, damage, injury, liability, cost or expense of any nature.
Terms & Conditions for Packages.
These terms and conditions apply to the following packages: Baby Bundle, Sleeping Beauties, Sleeping Gems, Saving Sleep, Sleepy Tots & Life Ready.

All consultation fees must be paid prior to commencement of initial consult. The Gentle Sleep Specialist reserves the right to postpone and or cancel consultation should payment not be finalised.
Should the client choose not to proceed after the initial consult, prior to receiving the emailed plan, the client is eligible for a 20% refund on the initial sum paid for the package.
Should the client choose not to proceed after the initial consult, once the plan has been emailed or at any stage during the first week follow up period the client is eligible for a 10% refund of the initial payment for the package.
Should the client choose not to proceed during the final week of follow up, no refund will be given.
The Gentle Sleep Specialist takes no responsibility for the results of the program.
If the Client becomes uncooperative, threatening, or if there is reason to believe that the parent is not taking reasonable steps to ensure the care and safety of the Child, The Gentle Sleep Specialist reserves the right to terminate services without refund.
The Gentle Sleep Specialist’s packages include once-daily follow up phone calls initiated by Tara Mitchell. Reasonable attempts will be made each day to make contact, however if the client is not answering the phone, The Gentle Sleep Specialist is not responsible, and no refund or substitute service will be provided.
During the two weeks follow up, should The Gentle Sleep Specialist may choose to send follow-up SMS text messages in place of a phone call if the Client and the Child are doing well.
If you are an international Client, phone follow up will usually be replaced with Skype arrangements and SMS text messages on every second day.
As a participant in The Gentle Sleep Specialist program, the Client is expected and encouraged to always follow SIDS safe guidelines.
Should you need to put the program on hold after commencement of the program, arrangements will be at the discretion of The Gentle Sleep Specialist.
By undertaking this program you are agreeing to certain aspects of controlled crying, there is no pressure to continue however refunds remain as stated above.

Definitions:
“The Gentle Sleep Specialist”: Tara Emma Mitchell, or any employee or contractor of The Gentle Sleep Specialist.
“Client”: the person receiving the services and/or information provided by the Gentle Sleep Specialist.

I have read and agree to the Terms of Service

Please read and accept the Terms + Conditions prior to submitting your form.

Payment Method

Prices are inclusive of GST.

Package Name*

Expectant Parents & Newborns (8 weeks and under)

Phone Consult ($195.00)
In Home ($ 295.00)

Sleeping Beauties | Phone Consultation Package

One Child ($495.00)
Twins (+$150)

Sleeping Gems | 90 minute In-Home Consultation

One Child ($595.00)
Twins (+$150)

Saving Sleep | 5 Hour In-Home Consultation

One Child ($ 995.00)
Twins (+$100)

Sleepy Tots | 3 Hour In-Home Consultation

One Child ($795)
Twins (+$100)

Coupon

Other Amount

*(only used if advised)

Total

$ 0.00

Credit Card

Card Details

Cardholder Name

*Important*Once you have submitted this form, please check your email for a receipt of confirmation. If you do not receive this email, we may not have received your details. Please allow up to 30 minutes for delivery and be sure to check your SPAM folder.

If you have received the confirmation, Tara will be in touch as arranged.

Phone

This field is for validation purposes and should be left unchanged.

Your Details

About Your Child

About Your Child's Sleep

Terms and Conditions.

Payment Method

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We'd like to thank Jessica Kate Photography for the use of her images on this website.