Parents’ full name
Email
Boy or girl’s full name
Child’s Date of birth
At how many weeks gestation your child was born? (Premature, 36, 37, 38, 39 weeks)
Was your child born via vaginal delivery or c-section?
Was your newborn in NICU? If yes, how long and why?
How was your pregnancy? Quiet, stressing…
How was your delivery?
Have your child’s developmental milestones been achieved on time? Rolling, sitting, crawling, walking, running, language.
Has your child been hospitalized?
Is your child allergic? If yes, explain.
What is your child’s sleep pattern? (is it hard for him/her to fall asleep, or does he/she wake up in the middle of the night?)
How is your child's nutrition? Is he/she a picky eater?
Write down your child’s routine.
Does your child have sensitivities?
What are the difficulties you have with your child?
What areas do you want to work with your child in the coaching session?
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