New Program Information

Baby (0-29 months) - Two Day Assessment Form

LET'S TRACK YOUR CHILD'S SCHEDULE

In order for us to understand the progress of your WEE one, please monitor your child over a two day period then answer the questions below in the spaces provided.

The information on this form is needed 48 hours prior to your initial meeting with your Dream Team Consultant. If you have any questions, please email us at child.sleep@wee-wellness.com.

Parent(s) Name

Phone

Child's Name

Child's Birthday

Month

Day

Year

Date Started

DAY ONE SCHEDULE

1. What time did your child wake to start the day?

2. What time did the first nap occur?

3. How did your child fall asleep for this nap? Please describe.

4. What time did your child wake from this nap?

5. What did you do when your child woke up? Please include feeding times, details, activities etc.

6. If applicable, what time did the second nap occur?

7. How did your child fall asleep for the second nap (if applicable)? Please describe.

8. What time did your child wake from the second nap (if applicable)?

9. What did you do when your child woke up from the second nap (if applicable)? Please include feeding times, details, activities etc.

10. If applicable, what time did the third nap occur?

11. How did your child fall asleep for the third nap (if applicable)? Please describe.

12. What time did your child wake from the third nap (if applicable)?

13. What did you do when your child woke up from the third nap (if applicable)? Please include feeding times, details, activities etc.

14. If applicable, what time did the fourth nap occur?

15. How did your child fall asleep for the fourth nap (if applicable)? Please describe.

16. What time did your child wake from the fourth nap (if applicable)?

17. What did you do when your child woke up from the fourth nap (if applicable)? Please include feeding times, details, activities etc.

18. What time did the bedtime ritual start?

19. What did you do for the pre-bedtime routine? Please list in order. (For example: bath, brush teeth, sing songs, read stories, play a game etc.)

20. What time was your child in bed for the night?

21. What time did your child fall asleep?

22. How did (s)he fall asleep?

23. What happened during the night? Please describe how many wakes, how you responded etc.

DAY TWO SCHEDULE