Classic form

Sleep consultant intake form with a three day sleep diary

No sleep plan can be written from one night, because one night is either the good one a parent remembers or the terrible one that made them book. This fifteen field intake form collects three days as a diary table, plus the room, the routine and the way the child actually falls asleep at bedtime.

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Before we start

Restful Nights. The diary is the part that takes three days. Start it tonight and send the form when it is done; nothing can be planned from a single night.

About you and your child

Your name *

Email *

Mobile *

Your child's name *

Your child's age in months *

Where and how they sleep

The answers below describe your child's sleep and health and are read only by your consultant. Nothing here is a judgement. Room sharing, feeding to sleep and bed sharing are all normal and none of them stops a plan from working; they simply change what the plan says.

Where does your child start the night? *

Own cot in their own room

Own cot in your room

Own bed in their own room

A bed shared with a sibling

In your bed

Somewhere else, such as a pram or the lounge

What is the room like? *

Dark enough that you cannot read in it

Light comes in at dawn

A night light is on

White noise is playing

A heater or air conditioner runs

Street or household noise carries in

A sibling sleeps in the same room

A screen is in the room

A sleeping bag is used

A comforter or soft toy is in the cot

The current routine, from dinner to lights out *

How does your child actually fall asleep at bedtime? *

Put down awake, falls asleep alone

Fed to sleep

Rocked or carried to sleep

Patted or held until asleep

A parent lies beside them

A parent sits in the room, not touching

In a pram, a car or a carrier

On a normal night, how many times do you go in? *

None

Once

Two or three times

Four to six times

More than six

We stopped counting

Three days of diary

One row per day, starting this morning. Naps means how many and roughly when. Night wakes means how many times and what settled them. Write what actually happened, including the night you brought them into your bed at four, because that is the night the plan has to account for.

Three day sleep diary

#	Day	Naps and times	Bedtime	Night wakes and what settled them	Morning wake
1
2
3

What you have tried and what you want

What have you already tried? *

A later bedtime

An earlier bedtime

Dropping or shortening a nap

Controlled comforting or timed checks

Staying in the room until asleep, then leaving

A gradual withdrawal over several nights

A dream feed

Cutting night feeds

A book, an app or an online program

Nothing structured yet

What would make this worth it for you? *

Has a GP, paediatrician or child health nurse reviewed your child's sleep? *

Yes, and nothing medical was found

Yes, and something is being treated

Yes, and we are waiting on a referral

No, but there is nothing I am worried about

No, and there are things I am worried about

Consent

By signing you confirm the information is accurate and understand that sleep consulting is education and support rather than medical care. Snoring, mouth breathing, choking in sleep, reflux, poor weight gain and anything else that looks medical is referred to a doctor before a plan starts. Any part of a plan can be stopped at any time without explanation.

Signature *

Every field, and what it collects

The complete field list, in the order respondents meet it.

Your nameShort textRequired
EmailShort textRequired
MobileShort textRequired
Your child's nameShort textRequired
Your child's age in monthsNumberRequired
Where does your child start the night?Single choiceRequired: Options: Own cot in their own room · Own cot in your room · Own bed in their own room · A bed shared with a sibling · In your bed · Somewhere else, such as a pram or the lounge
What is the room like?Multiple choiceRequired: Options: Dark enough that you cannot read in it · Light comes in at dawn · A night light is on · White noise is playing · A heater or air conditioner runs · Street or household noise carries in · A sibling sleeps in the same room · A screen is in the room · A sleeping bag is used · A comforter or soft toy is in the cot
The current routine, from dinner to lights outLong textRequired
How does your child actually fall asleep at bedtime?Single choiceRequired: Options: Put down awake, falls asleep alone · Fed to sleep · Rocked or carried to sleep · Patted or held until asleep · A parent lies beside them · A parent sits in the room, not touching · In a pram, a car or a carrier
On a normal night, how many times do you go in?Single choiceRequired: Options: None · Once · Two or three times · Four to six times · More than six · We stopped counting
Three day sleep diaryTable: Columns: Day · Naps and times · Bedtime · Night wakes and what settled them · Morning wake
What have you already tried?Multiple choiceRequired: Options: A later bedtime · An earlier bedtime · Dropping or shortening a nap · Controlled comforting or timed checks · Staying in the room until asleep, then leaving · A gradual withdrawal over several nights · A dream feed · Cutting night feeds · A book, an app or an online program · Nothing structured yet
What would make this worth it for you?Long textRequired
Has a GP, paediatrician or child health nurse reviewed your child's sleep?Single choiceRequired: Options: Yes, and nothing medical was found · Yes, and something is being treated · Yes, and we are waiting on a referral · No, but there is nothing I am worried about · No, and there are things I am worried about
SignatureSignatureRequired

What each block of this form collects

Four identity fields and one number, the age in months, which is the single figure every recommendation is indexed against. The where and how block is four questions that between them describe the sleep setting exactly: where the night starts, what the room is like, what the evening actually looks like written out, and the way the child gets from awake to asleep. That last one is asked as seven described methods rather than as a yes or no about self settling, because the difference between being patted and having a parent lie beside them is the whole plan. The diary is the evidence. The final block is what has already been tried, which stops a consultant proposing a failed method, what the family actually wants, and whether anyone medical has looked.

How to adapt this form

A newborn service for the first twelve weeks replaces the diary with a twenty four hour version, feeds included, and swaps the tried list for a feeding and settling question, since at that age the answer is rarely a routine change. A service working with school aged children drops the naps column, adds screen use in the two hours before bed, worries at bedtime and what time they actually have to wake, because the constraint there is the school bell rather than the nap. A practice supporting parents of children with additional needs keeps the structure and adds the diagnosis, sensory sensitivities and any medication that affects sleep, and lengthens the diary to seven days.

What makes this form work

Five columns across three days

Day, naps and times, bedtime, night wakes and what settled them, and the morning wake. Those five together show whether the problem is the bedtime, the naps or the wake time, which is the first decision a plan makes.

The going in question ends in we stopped counting

None, once, two or three, four to six, more than six, and we stopped counting. That last option is not a joke; it is the most accurate answer a parent of a four month old can give, and offering it keeps the rest of the answers honest.

The privacy paragraph says nothing here is a judgement

Room sharing, feeding to sleep and bed sharing are named as normal before any question is asked. Without that line, the form gets the sanitised version of the routine, which is the one no plan can be built on.

Questions people ask

Why does a sleep consultant need three days rather than one?

Because one night is not data. Parents book after the worst night of the month and remember the best one, so a single entry tells a consultant about the memory rather than the pattern. Three consecutive days show whether naps, bedtime and wakes are drifting together, which is what most plans actually fix.

What if the three days were unusual?

Send them anyway and say so in the routine field. A teething week or a trip away is still information, and a consultant would rather work from what happened than from a tidied version. The paragraph above the diary asks specifically for the night the child ended up in the parents' bed, since that is the night a plan has to account for.

Why ask how the child falls asleep rather than whether they self settle?

Because self settling is a phrase parents interpret differently. Seven described methods, from put down awake through fed to sleep, rocked, patted, a parent lying beside them and a parent sitting in the room, place every family precisely. The distance between the current method and the goal is what the plan has to cross.

Is a sleep consultant a medical service?

No, and the consent paragraph says so plainly. It is education and support. Snoring, mouth breathing, choking in sleep, reflux and poor weight gain are named in that paragraph as things referred to a doctor before any plan starts, which is why the form also asks whether a GP, paediatrician or child health nurse has already looked.

Why does the form ask what has already been tried?

To stop the consultant recommending something that has already failed, and to hear how it failed. Ten options cover the usual attempts, from a later bedtime to cutting night feeds, and ending the list with nothing structured yet lets a family who has simply been surviving answer honestly.

Does the room checklist really change anything?

More than most parents expect. Whether the room is dark enough to fail a reading test, whether light arrives at dawn, whether white noise is already running and whether a sibling shares the room each change what can be asked of the child. Ten ticks collect it faster than a description would.

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Sources

Written and checked by the OneCraft team. Last checked 20 September 2026.