Medical History for Lactation Consultation

The following questions are only for lactation/infant feeding appointments. Please be brief.

Please complete the below medical history information ONLY IF REQUESTED TO DO SO as soon as you have made a booking or at least 24 hours prior to your appointment.

* = mandatory response required

Please correct the following errors before submitting the form again.
Mother's details
If you are pregnant now, please complete this ANTENATAL SUMMARY:
Baby's details