Potty Training Questionnaire

We’re excited you’re interested in our package, but before you spend any money, we want to make sure your little one is ready to go. Please fill out our Potty Training Questionnaire below and we’ll get back to you with immediate next steps so we can get your big kid on the potty.

We appreciate your privacy.

The information you share with Sleep & Potty Co.® is confidential. This form helps us determine whether your child is ready to potty. Please answer all questions honestly and to the best of your ability.

What’s your full name?

First Name

Last Name

How should I address you?

What's your email?

What’s your phone number? When is the best time to reach you?

What’s your preferred method of communicating (email or phone)?

What’s your kid's name? What do they like to be called?

How old are they?

Does your child have any medical conditions? If yes, please provide more context so we can proceed safely.

Let’s see if your child is showing signs that they are ready to potty. Can your child understand and use words like “pee” and “poop”?

Is your child showing interest when you (their parents) are using the toilet?

Is your child waking up dry from a nap or staying dry for 2 hours?

Is your child telling or showing you when they are going in their diaper, or hiding when doing it?

Is your child showing interest in wearing big kid underwear?

Can your child pull their pants up and down on their own?

Do you consent to receiving Potty Training services from Sleep & Potty Co?

By checking "Yes" I consent to receiving Potty Training services with Sleep & Potty Co. I am aware of the benefits and potential risks of potty training and give full consent to the program. I understand there is no implied or stated guarantee of success or effectiveness of individual techniques or series of appointments. I acknowledge that potty training is not a medical service and understand Sleep & Potty Co. do not provide medical examinations, advice or diagnosis. I have stated all medical conditions that I am aware of and will inform Sleep & Potty Co. of any changes in my family’s health status.

Medical Disclaimer

The information/advice provided during this consultation is not medical advice. The advice is for informational purposes only and is intended for use with healthy children with common potty training troubles that are unrelated to medical conditions. The information provided is not intended nor is implied to be a substitute for professional medical advice. Always seek the advice of your physician with any questions you may have regarding a medical condition or the health and welfare of your child.

Potty Training Questionnaire

Sleep & Potty Co. ®