HEARTHSTONE MIDWIFERY, LACTATION & CRANIOSACRAL SERVICES
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Registering for a Lactation Consultation

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In order to prepare for our first visit, I ask that all clients fill out an intake questionnaire and review and sign my consent form.  I am happy to email them to you as attachments, or you can download them via the links below.  Please complete and return them before our visit if possible, or have them ready for review at our first visit. 

Please note that these are fillable pdf forms, which can be completed online.  Please download the pdf (rather than filling it out while still in a web browser), in order to ensure that your entries will be saved.  It may be wise to complete a few lines, then save it and double check, as not every computer is compatible with this option.  If you run into any trouble, you can always print and complete them by hand, then scan them for emailing.  If you do not have access to a scanner, just give me a heads up that I'll need to review your completed forms in person before we begin our session.  Thank you!

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Lactation Questionnaire
File Size: 104 kb
File Type: pdf
Download File

Consultation Consent Form
File Size: 85 kb
File Type: pdf
Download File


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  • Get in Touch
  • My Story
    • Biography
    • Why "Hearthstone"?
  • Virtual Services
    • Professional Classes >
      • Breast, Chest & Bottle Feeding for Professionals
    • Prenatal Classes >
      • Breast, Chest & Bottle Feeding Preparation
      • Newborn Care
      • Breast, Chest & Bottle Feeding + Newborn Care for Solo Parents
      • Childbirth Refresher & Sibling Preparation
    • Solo Parent Support
    • Lactation Consultation
    • Fertility Consultation
  • Local Services (SF North Bay)
    • Prenatal Classes >
      • Breast, Chest & Bottle Feeding Preparation
      • Newborn Care
      • Childbirth Refresher & Sibling Preparation
      • Breast, Chest & Bottle Feeding + Newborn Care for Solo Parents
    • Solo Parent Support
    • Fertility Assistance >
      • Fertility Consultation
      • In Home Insemination
      • Recommended Books & Supplies for Fertility
    • Lactation Consultation
    • Craniosacral Therapy for Infants
  • Resources
    • Local Family Resources
    • Virtual Resources
    • Recommended Supplies >
      • Supplies for Fertility
      • Supplies for Pregnancy
      • Supplies for Postpartum
      • Supplies for Feeding & Lactation
      • Supplies for Newborn Care
      • Supplies for Infants & Toddlers
    • Articles & Research
  • Get in Touch