Lactation Visit

Lactation Visit

Home - Office - Virtual
First and Last Name *

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Baby Birth Date*

MonthDayYear
Date
Type of Appointment*

In Office - Whittier, Ca - $200Home Visit (Initial) $250Home Visit (Follow Up) $225Virtual Visit $150
Any details about your breastfeeding concerns:*
Payment for lactation services is due at the time of your appointment with your lactation specialist. These visits are self-pay.

All lactation consults are done by an International Board Certified Lactation Consultant.

To reserve your appointment, a $25 non-refundable deposit is required. This deposit will be applied to your service.

Once we receive your inquiry and deposit one of our team members will be in touch with you by phone to schedule your appointment.

My Products*

Lactation Appointment DepositRemaining Balance is due at the time of your appointment.

$25.00 Quantity

Total

$0.00

By signing this document you agree to our payment schedule. Payments can be made with Zelle, Cash, or Card.

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