Lactation Community Resource

Brown County Community Lactation Resource
If you provide lactation services and want to be included on the Milk Map, please fill out the below survey. Thank you for your time and commitment to families in Brown County!

Note: if you are apart of more than one organization, please submit one form for each organization.
YesNo
Thank you for your interest! Unfortunately, we are only taking submissions for lactation supports who are either in Brown County or who serve the Brown County area.
Contact Person Name*
Email Address for Contact Person (we will use this to contact for yearly updates to map)*
example@example.com
Name of Organization (if you are apart of more than one organization, submit a new form for each organization)*
Address of Organization *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HospitalOutpatient Medical ClinicWIC (Women, Infants, and Children)Le Leche LeaguePrivate PracticeDoula ServicesMidwife ServicesCommunity OrganizationIndigenous Breastfeeding CounselorsOther
Hours of Operation
Organization Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization Email
example@example.com
Link to Organization Website
International Board Certified Lactation Consultant (IBCLC)Certified Lactation Consultant (CLC)Certified LactationSpecialist (CLS)Certified Lactation Educator (CLE)La Leche League Leader(LLLL)Peer EducatorIndigenous Breastfeeding CounselorOther
In home consultationsIn office consultations (i.e medical clinic, WIC, private-practice)Inpatient consultations (i.e. hospital setting)Virtual ConsultationsPhone ConsultationsBreast Pump FittingsBottle Feeding SupportPrenatal ConsultationsIn-person lactation classVirtual Lactation ClassIn-person Support groupsVirtual Support GroupsSupport person lactation educationPump RentalsTongue-Tie TreatmentBaby-Friendly Hospital Baby (babyfriendlyusa.org)Other
Please include any information about the above that you would like to share (ex. dates and times of support groups, cost of pump rentals, etc)
YesNo
If yes, what other language(s) are spoken by your lactation support?
YesNoOther
If yes, how can someone find out about the cost of service?
YesNo
If yes, how can someone find out if their insurance covers your lactation services?
YesNo
YesNo
If yes, what does the sliding scale fee look like?
YesNo
Name of person interested in mentoring:

First NameLast Name
Email address of person interested in mentoring:
example@example.com
Any other information you would like to share?
Should be Empty:

Brown County Community Lactation Resource