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National Lactation Referral Breastfeeding Family Application

To find a breastfeeding class, or a Lactation Consultant in your area, please complete form below. 

Click here if you would like an online visit with Lactation Consultant, or you would like to set up a local visit, or Breastfeeding Class.

  If you are a Lactation Professional who would like to register with National Lactation Referral.  Please click here to complete application.

Please fill out the following information:

Your Name
Address
City
State/Zip
Telephone
E-mail
 

List one or two hospitals nearest you.

1.
Name
Address
Phone

2.
Name
Address
Phone


If you are looking for a Lactation Consultant, please check all that apply:

Latching Difficulty
Sore Nipples
Infant Weight Loss
Engorgement
Implants
Reduction Surgery
Return To Work

Other, please explain: 

 
Please contact me as soon as possible regarding this matter.

 
 

 
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