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Breastfeeding Support – Lactation Consultant Booking Form
Book a session with a certified lactation consultant for expert guidance and personalized support. You can also contact us at hello@lavendercare.co
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* Indicates required question
Full Name
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Please select the option that best describes you
*
Please enter the product number
Pregnant
New Mum
Expectant Mum
How old is your baby/pregnancy
*
Please enter the product number
0--3 Weeks
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
Other:
Kindly select your current feeding method
*
Exclusive Breastfeeding
Mixed Feeding
Formula Feeding
Required
Kindly select your primary concern
*
Choose
Baby is not latching properly
Low milk supply
Painful nursing or sore nipples
Baby refusing breast
Plugged ducts or mastitis
Returning to work and breastfeeding
Kindly choose you preferred date and time
*
MM
/
DD
/
YYYY
Kindly choose you preferred location
*
Virtual
Physical
Preferred contact method
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Phone
Email
Text/WhatsApp
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Any other information?
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