Family Profile:

FAMILY QUESTIONNAIRE

So that we may provide you with the highest quality of care, please complete and submit the following questionnaire. We know some of the answers are guesses and that’s okay!  Be assured we never share or sell your information. 

What is your name and your partner’s name?

What is your address?

What is your child(ren)’s name and date of birth, or your due date?

What is your phone/text number and email?

Which do you prefer we use?

How many nights per week do you wish to have service? Any preference on nights of the week? (We know this might be a guess!)

What is the approximate date for service to begin?

What is your best guess for how long you’d like to have care?

Which timeframe do you prefer? 10p-7a or 10pm-6a? We can also accommodate other times but these are the most common.

Do you know if baby will be breast or bottle feeding?  Are there any medical needs of which we need to be aware?

Do you have other children? What are their names and ages?

Do you have any pets? What type?

Are there any food restrictions in the home?

Where will the caregiver and child be set up? (The living room usually works best!)

Is there anything else you would like us to know? Do you have any requests we may accommodate?

Who may we thank for referring you to Let Mommy Sleep?