Sunshine Lactation Client Intake
Intake form for Sunshine Lactation clients
Email address *
Your Full Name (as appears on insurance) *
Baby's Full Name
Baby's Sex
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Baby's Date of Birth
MM
/
DD
/
YYYY
Baby's Birth Weight
Pediatrician's Name and Fax Number
Multiples
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If you wish to have anyone present during our visit, please list them here
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