Balanced Breastfeeding Appointment Request
Please complete the form below to request an appointment. 

If you have already had an appointment for this pregnancy and/or baby, do NOT fill out this form. Please email to schedule.

We are fully booked for clients due/that have delivered in August. Currently booking those due in September and later.
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First Name *
Last Name *
Email Address *
Phone Number *
Reason for appointment? *
When is your due date or when did you deliver? *
You can share more details about your need for the appointment here. (Optional)
Do you have a preferred lactation consultant? If so, mention below.
Have you had an appointment at Balanced Breastfeeding before? *
When would you like to schedule an appointment? (If you are pregnant, include SPECIFIC DATES & TIME OF DAY. We recommend the visit between 28 and 32 weeks.) Appointments are in person at our office in Wilmington, DE. *
I have reviewed insurance and fee for service pricing and understand I am responsible for the cost of the visit if not approved for insurance coverage through The Lactation Network PRIOR to my appointment day and time. The TLN form must be completed for approval. *
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