Birth Encouraged: Certified Lactation Specialist Consultation
Please send me a text at (906) 366-0347 to schedule a prompt appointment. Before your appointment, please fill out this form to provide me basic information and context before your appointment.
Your Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Appointment Date
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Month
-
Day
Year
Please note our scheduled appointment date.
Baby's Name
First Name
Last Name
Baby's Birth Date
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Month
-
Day
Year
Where was Baby born?
Name of hospital, birth center, or home birth
Who is your provider?
OB, midwife, or practice
Please tell me briefly about your birth.
Gestational age at birth? Was Baby born vaginally or via cesarean? Please specify any interventions: induction, pitocin, epidural?
If this is your first baby (or your first time breastfeeding), please briefly describe your breastfeeding preparation prior to birth.
Classes, books, podcasts, secondhand learning from friends/family, etc
If you have breastfed before, please briefly describe any prior breastfeeding experience.
How many children have you breastfed? Did you have any struggles that marked those journeys?
Please describe the current breastfeeding struggles for which you are seeking a consultation.
When did these struggles begin? Have you found anything that has helped? Are there things you have tried that haven't helped?
Would you like me to bring my scale to weigh Baby and/or to do a weighted feed?
Yes, that would be helpful
No, that's not necessary
Are there any other specific questions or concerns you would like to address during our time?
How did you come across my name?
If someone referred you to me, please let me know who so I can thank them!
Important Reminder:
For the best evaluation, please try to make sure that Baby is comfortable but ready to eat at the time of my arrival. This usually means trying not to feed Baby for about two hours leading up to our appointment time.
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