Breastfeeding Help Near Me | Breastfeeding Help | BABS

What is a summary of the concerns you have? Please list any underlying health issues such as PCOS, Gestational Diabetes, Postpartum Hemorrhage, C-section Delivery, Preterm Labor, IUGR Baby, Infant Cardiac Defects, Breast Reduction or Augmentation Surgery, History of Breast Radiation, Thyroid Problems, Infant Jaundice, Forceps Delivery, High Infant Weight Loss, or problems breastfeeding any prior children: *

I'm vaccinated *

Yes No

I am willing to accept a vaccinated IBCLC intern during my consult: *

Yes that's fine No Thanks I have additional questions

Informed Consent and Release. I give my consent for Bay Area Breastfeeding Support (BABS) to work with me and my baby concerning our breastfeeding situation. This consent is for in-person visits, telephone conversations, and/or information sent by e-mail, fax or regular mail, and includes appropriate follow-up contacts. I give consent for BABS, to perform any or all of the following: Observation of the mother and infant feeding; Analysis of the available data relating to the breastfeeding situation; Demonstrate techniques for improving breastfeeding and, where appropriate, the use of breastfeeding equipment; Visual and physical assessment of the mother’s breasts which may involve physically touching the mother’s breasts; Visual and physical assessment of the infant’s mouth, which may involve insertion of gloved fingers in the mouth of the baby. I understand that all medical care for myself and my baby is to be provided only by my/our own physician(s). I give permission for information about this and all additional consultations to be shared with and sent to (by electronic or other means) my physician(s) and/or other health care provider(s). *

I consent to wear a mask during our visit in person, I will cancel our appointment if I have been sick within the last 10 days, I understand that Serena is vaccinated against covid-19 and all other transmittable diseases, I understand that Serena wears her mask during the visit and will not see you if she has any symptoms of illness or known exposure. I understand that I do not have to have an lactation intern at my appoint if I choose not to. *

yes

Book an Appointment by filling out this form!

Please Enter Insurance Information so we can offer you a superbill for INSUANCE reimbursement.