Name *

First Name

Last Name

Phone

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Requested appointment date (to be confirmed with The Milkmaid)

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DD

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Please select your main areas of concern

Antenatal education & what to expect

Positioning & attachment techniques

Engorgement, mastitis or blocked ducts

Damaged painful nipples & nipple shields

Tongue Tie & referrals

Low milk supply & over supply

Slow weight gains

Combination feeding