Name *

First Name

Last Name

Phone

(###)

###

####

Is this your first baby?

Yes - This is all new!

No - Our family is growing!

Estimated Due Date (or baby's birthday if already born) *

MM

DD

YYYY

Did you know the secret to a successful and enjoyable breastfeeding journey is to meet with a Lactation Consultant BEFORE your baby arrives?

Yes

No

Did you know that breast pump flanges are not "one size fits all"? Standard flanges typically provided with pumps don't work for most people leading to nipple pain, damage and low milk volume. Size matters! Your Lactation Consultant can measure to determine your best fit. Do you know your ideal flange size?

Yes - I have been measured recently.

No - I need to be measured.

The best time to meet with your Lactation Consultant is early in the 3rd trimester to establish care, review your history, concerns and learn about breastfeeding basics. A follow-up visit around 35-37 weeks is recommended to learn helpful tips and practice techniques to ensure success from the start.

Please check the box below if you would you like us to contact you to schedule a consultation.

Yes, I would like to schedule a consultation.