I'd like to ask you to take a few minutes and answer some questions about your child before we talk in person. This will help me prepare for our meeting, and will let us make the best use of our time together. There are quite a few questions, but most can be answered in a word or two, so please don't be intimidated.

Answer the questions below in the space provided and submit at least 1 to 2 days before out meeting. Any questions, please email me at anna@littlewinks.ca

Name *
Name
Phone *
Phone
Address *
Address
Child's Name *
Child's Name
Child's Birthdate *
Child's Birthdate
(Picky eater, healthy appetite, only eats the same 5 things)
What time is dinner? *
What time is dinner?
1 being "it's a party with night lights everywhere" and 10 being "I can't see my way so I have life long injuries from lego"
What time does your child start the day? *
What time does your child start the day?
What time do you start the bedtime routine? *
What time do you start the bedtime routine?
What time is he/she actually asleep? *
What time is he/she actually asleep?