BOOBY FOOD CLIENT INTAKE FORM

Order #*

Name*

First NameLast Name

I have used Booby Food services before

I've paid a deposit with my appointment

YesNoPrepaid

Service Date*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

I would like to have my Booby Food shipped back to me via

Are we shipping/delivering your Booby Food back to this address?*

YesNo

Shipping/Delivery Address (if different from above)

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Will there be an alternative person receiving your Booby Shipper or Booby Food on your behalf that we can note on the shipping label?

My Date of Birth*

Date

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

My babe's name is*

and was born on:*

Date

According to the Academy of Breastfeeding Medicine, breastmilk is safe almost indefinitely, if kept frozen.
Breastmilk 12 months and under is acceptable to be used in a bottle. If your breastmilk is older than 12 months, it's recommended to be used when adding to foods.

I prefer to be contacted via

TextEmail

How is Booby Food Receiving Your Frozen Breastmilk?*

Local Drop Off (Calgary, AB - by appointment)I'm Shipping (USA + International)I'm Shipping (within Canada)Other

Your Booby Shipper(s) will be sent 2-3 weeks prior to your scheduled service date. If you need your Booby Shipper earlier, please let us know.

Regular shipping is fine with meI need by Booby Shipper ASAP!

If needed ASAP, please let us know when you need your Booby Shipper by

I acknowledge that I will receive an initial invoice for shipping fees, due upon receipt. A final invoice for my processing service and return shipping (if applicable) will follow once my Booby Food is shipped back to me.

YesN/A I am taking care of getting my frozen milk to Booby Food

If Shipping: Do you want us to send you the All-in-One Booby Shipper(s)?

Yes! Send me the All-in-One Booby Shipper(s).No, I'm following Booby Food's DIY instructions at https://www.boobyfood.com/shipping

Do you want to be placed on an early shipping list for the All-in-One Booby Shipper?

Yes! Send one ASAPNo, I'm okay waiting until 2 weeks prior to my service date

This section must be completed by the mother supplying the breastmilk

I, Name* hereby release approximately amount* oz of my frozen breastmilk in brand of milk storage bag(s) * bags to Booby Food for the purposes of freeze drying into powder and packaged into 15g bags. *brand of milk storage bags will determine the shipper kit sent to you.*

I confirm the frozen breastmilk being released to Booby Food is:*

My ownMy surrogate's

   I confirm the breastmilk being released to Booby Food is:
Frozen*
Has not been previously thawed*
Is for my own personal use and not for resale*

I used a blanks brand breast pump to express my milk. Model (if known): blank .

Have you used any lactation aids while pumping?

YesNo

If yes, please share what you've used i.e. fenugreek, domperidone, lactation cookies, etc

If yes, please share below.

Have you had any complications while breastfeeding/pumping during this stash? i.e. blocked ducts, mastitis, cracked and bleeding nipples, etc.

YesNo

There are 4 major contraindications to breastfeeding according to the CDC, AAP and CPS:

Infants with galactosemia, a rare metabolic disorder, and

Breastfeeding mothers who are:
HIV, HTLV – 1/2 positive and are not on HIV treatment (antiretroviral therapy or ART), or are on ART but have not achieved sustained viral suppression during pregnancy (at a minimum throughout the third trimester) or at the time of delivery.
Confirmed or suspected to be infected with active Ebola virus.
Currently on active radiological, chemotherapy drug therapy.

Most medications are safe to use while breastfeeding. The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate

By submitting your frozen breastmilk to Booby Food, you understand and confirm your breastmilk is not contraindicated by the above.

Viruses can be transmitted through breastmilk and as such, an infant or child may be susceptible by ingestion of contaminated milk. Please indicate if your breastmilk contains or is suspected may contain any of the following (check all that apply).

Booby Food makes every effort to ensure all safety and hygienic food handling practices are followed according to Good Manufacturing Processes, provincial and federal health regulations. I authorize Booby Food to inspect and reject my frozen breastmilk if there is evidence of possible contamination (bag rips, tears, punctures, holes or otherwise not specified).

How would you describe your breastmilk?

WateryAverageFattyOther

Lipase is a naturally occurring enzyme in breastmilk, and some mama's lipase activity is different than others, causing their frozen breastmilk to have a less sweet smell or taste - especially when frozen for a long time. This is due to the fats being broken down while sitting in your freezer.

High lipase breastmilk is not contraindicated and is safe for your babe, but some may be put off by the taste/smell.

Freeze-drying helps to mild out high-lipase breastmilk since removing the water puts this enzyme in a "sleep" mode, preventing further breakdown of fats. Mothers share that their babes wouldn't have taken their frozen breastmilk before, but will take a bottle with their freeze-dried breastmilk.

Note: Every mama's milk and every babe's taste preferences are different. Freeze-drying doesn't eliminate the lipase enzyme, but has been known to tame the intensity.

Do you have/suspect high lipase in your breastmilk?

YesNoI Don't Know

Booby Food offers lab-certified nutritional testing for your freeze-dried breastmilk. Testing is done from one of our 3rd party labs, ensuring reliability and trust.
We have 2 nutritional service packages to choose.
*Requires (1) 15g bag and an extra week for lab testing.

Basic Nutritional Testing - $139CAD (~105USD)

Calories, Total Fat, Protein, Carbohydrates

Premium Nutrition Testing + Analysis - $239CAD (~175USD)

Includes testing and a 7-page personalized breastmilk analysis w/ diet and lifestyle recommendations

Would you like to add on nutritional testing services?

Yes! I’ve already included nutrition testing on my service when I bookedI changed my mind, YES! Please add the premium nutritional testing + analysis on to my service nowI changed my mind, YES! Please add basic nutritional testing on to my service now.No. Not at this time, thank you.

Nutrition results take about a week to come in after your breastmilk powder has been packaged. How would you like to receive your Nutrition results?

Physical sticker on my Booby Food box for quick reference - mom brain, you know?Digital only so I can receive my Booby Food sooner. I'm so excited!

Lab testing will take approx. 1 week and we will email your results back via PDF to have for personal use.

Nutrition results are for informational purposes only and shall not be intended or used for medical advice. Share your results and consult with your healthcase provider prior to making any health choices

Your Booby Food Service Timeline:

Typically orders up to 600oz take 3 weeks to complete, starting from your service date (unless alternative arrangements have been made eg: Rush orders/moving/special situations). Here's the timeline of what to expect from your Booby Food Service:

Week 1: intake, documenting, photographing

Week 2: the magic is happening and your stash is freeze-dried!

Week 3: packaging, custom labeling, boxing, and the journey back home to you.

*Nutritional testing may add a few days as we await your results from our 3rd party labs.

**Orders over 600oz will take longer (unless alternative arrangements have been made).

***If you send in your stash earlier than your service date, you will be placed on a cancellation list and prioritized for early processing if available.

How to Safely and Hygienically Express and Store Breastmilk
https://www.cdc.gov/breastfeeding/pdf/preparation-of-breast-milk_H.pdf

How to Safely Mix Formula
https://myhealth.alberta.ca/health/pages/conditions.aspx?Hwid=tj8037

Booby Food FAQs

https://www.boobyfood.com/faqs

I have received information about, and confirm all of the following:*

Booby Food documents and weighs your breastmilk before freeze drying. We don't complete orders for your service until after confirming the amount of breastmilk we receive. If the amount of breastmilk given to Booby Food is over your booked service, how would you like us to proceed?

Please go ahead and freeze dry all of my breastmilk and charge accordinglyPlease contact me to discuss any extra chargesReturn the extra bags with my Booby Food delivery (extra shipping fees may apply)Discard the extra breastmilk bags that are over my booked service amount

If you prefer to stay within your booked service amount, what date of breastmilk would you like freeze dried in priority?

Please freeze dry the most recent dated breastmilkPlease freeze dry the oldest dated breastmilkPlease combine oldest and most recent dated breastmilk

I would like a detailed receipt I can submit to insurance, please.

YesNo

How did you hear about Booby Food?

Eg: Can we thank a special person? Or were you scrolling on social media?

Do you need your Booby Food back by a certain date? If yes, please explain.

Please note this is a request only - we will do our very best to get your Booby Food back to you ASAP.

Special Requests?

eg: My babe developed a dairy sensitivity and I have breastmilk from before I changed my diet. Please freeze dry the bags labelled "contains dairy" separately from the "dairy-free diet"

Allergy/Sensitivity Disclaimer:

Booby Food only offers private chamber processing for each client. Your breastmilk is exclusively handled and never in the same chamber as another mother.

If your requests involve separating your breastmilk for allergy/sensitivity containing foods, it is up to you to clearly label the breastmilk we are freeze-drying separately.

Booby Food is not responsible for allergen containing breastmilk that is not clearly identified and separated.

Your Booby Food will not be shipped/delivered without payment. We will send you an invoice through our Square booking system. To avoid unnecessary delays, what is your preferred payment method for your Booby Food service? (select all that apply).

I have a gift card(s) I'd like to use, whoo hoo!Charge the card I used to book my Booby Food serviceI'd like to use a different card for my Booby Food service payment, contact meI'll e-transfer hello@boobyfood.comOther

I have read, understood and confirm the information contained within the Booby Food client agreement. If I have any questions or concerns, I will contact Booby Food at hello@boobyfood.com or (587) 355-7812.

Signature*

Date Signed:

Date

Want to be a Featured Client?

Mamas often feel comfort and support in others sharing their journey, struggles, triumphs, and well, just mamahood experiences around breastmilk, supply, and breastfeeding/pumping. It’s one of those topics that isn’t talked about openly, maybe because of the unrealistic societal expectations that all mamas should automatically be perfectly abundant in their supply and breastfeeding should come easy.

Booby Food wants to build a support system for mamas, whatever their journey is. If you would like to be a featured client or share your story for other mamas to read, drop us your Instagram handle and share your story!

You never know, just reading about another mama's journey can be the difference between a bad day and a sigh of relief.

*featured clients are not guaranteed on social media, but maybe uploaded to our website's Mama Stories

Instagram Handle

eg: @iloveboobyfood

TikTok Handle

eg: @iloveboobyfood

Do You Want Your Instagram Handle Displayed Publicly?

No. Please hide my Instagram handle.Yes, please show my Instagram handle!N/A

Share Your Booby Food Story:

What Are Some Of Your Fav. Songs/Artists

Feel free to drop any pictures you'd like us to share in your Booby Food Client Story.

Cancellation Policy:

Although rare, if you decide not to save your stash and cancel your order, please let us know ASAP.

Your service is 100% refundable if canceled before we have sent your Booby Shipper.

If you decide to cancel after we have shipped your cooler, you will be charged for all shipping fees. Shipping fees are prepaid and once your Booby Shipper is in transit, they cannot be refunded. Shipping fees are charged at a rate of $1/oz USD for orders canceled after sending your Booby Shipper. The outstanding balance after shipping fees have been deducted from your order will be refunded back to the original payment method.

The All-in-One Booby Shipper(s) are unique and specially designed coolers and must be returned within 30 days of delivery or you will be charged $275USD/ea for replacement + a $25USD restocking fee.

By submitting this intake form, you understand and agree to our cancellation policy.

www.boobyfood.com | 587-355-7812 | hello@boobyfood.com

Booby Food Client Agreement