Awesome Breastfeeders' Sliding Scale Application
Thank you for considering me for your birth and/or lactation support needs. I am honored to work with your family. To be considered for my sliding scale pricing, please complete this application. Applications need to be processed and approved prior to scheduling your connection. Refunds will not be issues on connections scheduled prior to your application being processed.

You will be contacted shortly via email after your application has been received.

Lydia O. Boyd, IBCLC, CBE-Expert, CLE, Doula
lydia@lydiaoboyd.com
www.lydiaoboyd.com
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Email *
First & Last Name *
Birthday *
MM
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DD
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YYYY
Your Address *
How do you racially identify? *
Due Date *
MM
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DD
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YYYY
Household Monthly Income (including your and your partner's income) *
Highest Educational Level *
Partner's First & Last Name *
How does your partner racially identify? *
Highest Educational Level (Partner) *
Do you or your partner receive income from any of the following: *
Required
Do you or your partner receive Food Stamps (TANF or CALfresh)? *
Required
How much is your residential rent (or mortgage) monthly? *
Do you receive Section 8? *
Do you receive WIC? *
If you are a WIC participant, are you assigned to a WIC Breastfeeding Counselor? *
Due to COVID-19, have your or your partner experienced any of the following: *
Are you receiving any of the following because you were financially affected by COVID-19? *
Sliding scale pricing applies to the following services:
* Prenatal Breastfeeding Class
* Virtual Consults - 1 Hour
* Phone Consults = 1 Hour

I understand that my application, if approved, will apply to the above services.
 *
By completing this application, you are not guaranteed a discounted price for lactation or birth support services. By accepting sliding scale pricing, you are agreeing to all of the requirements of working with Lydia O. Boyd, Lactation Consultant. i.e., completing in-take and consent forms and adhering to all policies and requirements. 

I agree to the above.
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