• Durham's Maternal Stress Free Zone Pregnant and Breastfeeding Mother Program

    New Client Intake Form
  • To qualify for the Program, you must:

    *Currently be pregnant

    *Thinking about or planning to breastfeed

    * Currently breastfeeding

    * Live within the city of Buffalo.

    Thank you for taking the time to fill out this form so I can get to know you better and have an idea of how I can best support you during your pregnancy, birth and postpartum!

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  • About you and your baby

  • Birth and Breastfeeding Goal Questions

  • Should be Empty:
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