Sunshine Lactation Client Intake
Intake form for Sunshine Lactation clients
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Email *
Your Name (as appears on insurance) *
Your preferred pronouns *
Baby's Name (as appears on insurance) *
Baby's Sex *
Baby's Date of Birth *
MM
/
DD
/
YYYY
Baby's Birth Weight
Pediatrician's Name *
Pediatrician's 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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