Free Email Consultation Request
Welcome to Restoring Rest! I am so glad you are here and taking advantage of this free, no strings attached consultation.

This questionnaire provides me with a quick overview of your child’s current sleep habits and what you’d like to change about your situation. After you submit this form, I will send you an email within 24 hours, including details about how I can help you achieve your specific sleep goals and various support options should you desire to move forward.

In the meantime, please visit my website at www.restoringrest.com for more information. If you prefer a free 20-minute phone consultation, please click here.

I look forward to hearing from you!
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Parent's Information
What is your first and last name? *
What is your email address? *
Child's Information
What is your child’s name? *
How old is your child?  *
What is your child's birthdate? *
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Was your child born early? If so, how early?
How much does your child weigh?
Does your child have any medical conditions?
Background Information
Please share with me your biggest concerns regarding your child’s sleep. *
What do you wish to accomplish by working with me? (Longer naps, sleeping through the night, wean nighttime feedings, better daily schedule, etc.) *
Daily Schedule & Sleep Environment
Briefly describe your child's daily schedule. (It's perfectly ok if you don't have one yet!)
Where does your child sleep during naps and at night? (crib, bassinet, pack-n-play, car seat, baby carrier, co-sleep, etc.)
Briefly describe how you put your child down for naps and bedtime.
Questions & Concerns
What questions or concerns can I answer for you regarding sleep training, working with me, etc.? 
Is there anything else you would like to share with me?
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