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Processing Grief with Low Supply Counseling Intake Form
Low Supply Mom, 2021.
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What's your name?
Your answer
What's the best email to use for communication?
Your answer
Please describe what practice best fits your current feeding method
Combo-feeding, nursing and bottles
Combo-feeding, pumping and bottles
Exclusive formula and/or donor-milk feeding
No longer feeding infant
Clear selection
On a scale from 1 to 10, please rate the impact that grief associated with low supply has on your life
no impact
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debilitating impact
Clear selection
On a scale from 1 to 10, please rate the impact that formula-feeding stigma has had on your life
no impact
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10
debilitating impact
Clear selection
On a scale from 1 to 10, please rate the impact that lack of medical support regarding low supply has had on your life
no impact
1
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10
debilitating impact
Clear selection
What are you hoping to gain from low supply grief counseling?
Your answer
Please submit general availability
Your answer
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