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Brief Reflection Questionnaire 

Accessing the learning modules is a simple two-step process:

Step 1: Complete the brief questionnaire below.
Step 2: After submitting the questionnaire, you will receive an email with

instructions to sign up for your FREE Lotus Project membership.

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Once your free membership is activated, you will gain access to the learning modules beginning March 1, 2026.

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At the conclusion of the project on March 27, 2026, you will be asked to complete the questionnaire one final time. After submitting the final questionnaire, you will receive a complimentary copy of 5 Secrets to Calm, Connected Parenting and an exclusive discount for Feeding From Instinct, a revolutionary course created by Dr. Kaitlin Ploeger.

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All personal information is protected with WIX HIPAA Compliance & in accordance with the Luna Wolf Child Development LLC Privacy Policy

Date of Birth
Month
Day
Year
Have you given birth within the last two (2) years?
Yes
No
Did your child spend any time in the NICU?
Yes, more than 3 months
Yes, less than 3 months
No, my child did not spend any time in the NICU
Which of the following have you experienced in the last two (2) postpartum years, if any? Select all that apply
In the past 7 days I have been able to laugh and see the funny side of things
In the past 7 days I have looked forward with enjoyment to things
In the past 7 days I have blamed myself unnecessarily when things went wrong
In the past 7 days I have been anxious or worried for no good reason
In the past 7 days I have felt scared or panicky for no very good reason
Even though I may not always manage it, I know what I need to do with my child
In the past 7 days I have been so unhappy that I have had difficulty sleeping
In the past 7 days I have felt sad or miserable
In the past 7 days I have been so unhappy that I have been crying
In the past 7 days the thought of harming myself has occurred to me
Even though I may not always manage it, I know what I need to do with my child
I am able to do the things that will improve my child's behaviour
I can make an important difference to my child
In most situations I know what I should do to ensure my child behaves
The things I do make a difference to my child's behaviour
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