Client Forms & Resources

Standard Client Intake Form

If you are a new client, or it's been a while since I've seen you, please fill out the client intake form by pressing the button below. This will allow me to prepare for our appointment.

Intake Form

Pumping Intake Form

This form is specific to clients that are experiencing issues or concerns with pumping or breastpump flange fitting.

Intake Form

HIPAA Form

This form displays our HIPAA privacy policy and your rights regarding your personal medical information. All clients must have reviewed and acknowledged receipt of HIPAA policies.

HIPAA Form

Consent Form

All clients must have a Consent Form on file. This form includes consent for: evaluation and treatment of parent and baby, media release, report release to client's healthcare provider and/or baby's healthcare provider, permission to bill client's insurance company, and describes scope of practice for the Lactation Counselor. Clients may request to change permissions for any of these items at any time by filling out a new Consent Form.

Consent Form

Prenatal Education Guide

Clients with an email address on file have access to the Nurture & Nourish Prenatal Education Guide. This guide is exclusive to clients at this time.

Prenatal Education