Breastfeeding Consultation Forms

We’re so excited to be working with you!

To the right, you will see several forms that you can download, read, fill-out, and/or print.

If you’re able to process these forms before your consultation, it will allow the lactation consultant or breastfeeding counselor to spend more time working with you and baby, hands-on, instead of completing forms. If you’re unable to get to it, don’t worry! We’ll bring hard copies with us either way.

1) Notice of Privacy Practices, HIPPA- read and keep for your records
2) Patient Information and Consent Form- please print and fill it out
3) ICD9- Insurance form- please print and we’ll fill it out
4) Breastfeeding Questionnaire…. filling this one out will save us the most time!
 If you don’t have a printer, no worries: you can edit it on the computer and then send it back to us before the consult.
See you soon!