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Intake Form
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(917) 922-6143
Tell us about your little one...
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Parent's Name
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Last
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Email
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Phone
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Home Address
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City
State
Zip Code
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Child's Name
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Child's date of birth
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Siblings?
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Age of sibiling(s)
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Tell me briefly about the delivery
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Why did you contact me?
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Does your child have any health issues, including allergies?
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Have you tried any sleep training methods before? Which ones?
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Where does you child sleep now?
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What is your current bedtime routine?
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What time does your child wake up in the morning?
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What time do you leave in the morning?
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Does your child take naps? What times?
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What goal would you like to reach with HUSHbyHillary?
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At how many weeks was your child born?
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About
Services
Intake Form
Contact
Blog
(917) 922-6143