Lactation Support Request

Use this form to submit a request for a lactation support consult. MSP covers consults for clients in pregnancy, needing support for a variety of reasons to prepare for the breastfeeding journey. MSP also covers lactation support for parents and babies up to 42 days (6 weeks) postpartum. Thereafter, the service is not covered and considered private pay.

Name (As appears on Care Card)*

Are you a current patient of Semiahmoo Midwives?*

Date of Birth*

Care Card Number*

Email address:

Phone Number:

What stage of pregnancy are you currently at?*

Newborn Date of Birth

Feel free to elaborate on why you are seeking a lactation consultation.