Application for 3-Month Breastfeeding Mentorship
Once you submit this form, your responses will be reviewed same business day (or next business day if after business hours). We will then be in touch with you to set up scheduling and payment.
What is your first name?
What is your last name?
What is your email address?
Please describe the biggest challenge you are facing either with breastfeeding that you would like support with.
Wanting to induce lactation/relactate
How would you rate your understanding of breastfeeding (latch, milk production, diet, infant oral function) on a scale from 1-10 - 1 being very poor (I know nothing!!) to 10 being extremely confident (stellar knowledge level)
Please list below any previous books, courses, or other information products you have used to learn about breastfeeding (i.e. Womanly Art of Breastfeeding, websites, blogs, etc.)
What are you hoping achieve by the end of our time working together?
Which time zone do you live in?
Please indicate your preferred payment schedule: *Please note that payment is required to secure your spot in the program upon registration
One payment of $1197 USD
$457 USD per month (3 months)
Please provide your telephone number:
Where did you hear about Jacqueline Kincer/Holistic Lactation?
Thank you for submitting your application and joining the waiting list! If you have questions please email me at:
Please note that payment (either full or the first installment if you choose a payment plan) is required upon registration for the 3-Month Breastfeeding Mentorship Program. You will be notified as soon as a spot becomes available. Looking forward to working with you! Enjoy the rest of your day! --Jacqueline
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