DC/Maryland Breastfeeding-Friendly Healthcare Provider Office Recognition Awards
Nomination/Site Inspection Form 2021
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Email *
Healthcare Provider Office Name *
Office Address: *
Nominator (first and last name) *
Contact Person (Office Manager or Human Resource Manager) *
Contact Person E-mail Address *
Phone Number *
Size of Business *
Check all criteria that you can verify:
Practices will be recognized as follows:
Bronze Award: 10-16 points
Silver Award: 17-24 points
Gold Award ≥ 25 points (at least 2 gold criteria must be met)
Bronze (1 Point each)
Silver (2 Points each)
Gold (3 Points each)
Please feel free to share any additional details about your breastfeeding supports.
A copy of your responses will be emailed to the address you provided.
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