Apply to Become a Mamalyfe Donor Mom
We're building a new standard – one that supports mothers, honors milk, and feeds babies with the very best. Complete the short screener below to see if you qualify to join our donor network. All submissions are confidential.
Basic Info
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Zip Code
What's your ZIP Code?
How did you hear about Mamalyfe?
Instagram
Facebook
TikTok
Internet Search
Friend/Family
Hospital/Clinic
Daycare
Other
Milk & Pumping Info
Are you currently lactating?
Yes
No
I'm pregnant but will breastfeed/pump
Do you have any medical conditions that could impact the safety of your breast milk?
No
Yes (we'll follow up privately if selected)
We're unable to accept milk from moms with certain conditions like HIV, HTLV, untreated hepatitis, or active infections that may pass through breastmilk – but we deeply honor and respect every mom's journey.
Are you currently breastfeeding, pumping, or both?
Breastfeeding
Pumping
Both
Neither
On average, how many ounces do you pump daily?
Estimate is fine – we know that the numbers vary
Would you be open to pumping for donation if compensated?
Yes
No
Maybe
Have you used a breast pump before?
Yes
No
If yes, which pump(s) are you currently using?
Include brand and model (bonus point if you tell us how it's working for you)
Health & Lifestyle
What medications and/or supplements are you currently taking?
Do you smoke or live in a household with smoking?
Yes
No
How would you describe your diet?
Balanced
Organic-focused
Vegetarian
Vegan
High Protein
Other
Commitment & Consent
How long would you ideally be able to donate?
Please Select
1-2 months
3-6 months
6+ months
Undecided
Are you willing to complete a health screening if selected?
Yes
No
Do you agree to be contacted by our team regarding next steps if selected?
Yes
Consent Checkbox
I confirm that all answers provided are accurate to the best of my knowledge. I understand this is a preliminary application and does not guarantee acceptance into the Mamalyfe donor program.
Submit
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