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Lactation Consultation Intake Form

Please complete the entire intake form. Consultation fee appreciated prior to your visit and can be paid with credit card or health care savings.   Once you’ve completed the form please contact Ann by email at aconsmith@gmail.com or text or phone at 919-389-1599 to confirm your appointment details.

Telemed Consultation

You will receive a notice of Zoom appointment in your email and it will include a link to click to get into waiting room from where I will bring you in.

In advance of our consultation it is helpful if you provide me with:

  • Video clip of baby latching and nursing (send to my phone 919-389-1599)
  • Video clip of pumping if you do pump so that I can actually see how the shield is fitting you.
  • If at all possible it is very helpful to be able to see under baby’s tongue. I know this is not easy so if you can’t, I understand. Sometimes, when baby is crying and you catch that, I can see under tongue that way. Alternatively, you can try this https://www.youtube.com/watch?v=5JuDSmX93Zw

It is difficult to do virtual consultation when you are alone so if at all possible, have someone in the room with you who can move the camera as needed.

Baby needs to be ready to nurse sometime during our consultation.



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