Intake Form—Office/Telehealth Visit

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These intake forms are specially designed for lactation consultants answering initial client calls to ensure all important information is consistently requested and recorded.  Two versions included:  home visit and office visit.  

NOTE:  THE BLUE SAMPLE IMAGE SHOWS THE NEW 6.0 DESIGN, ESTIMATED RELEASE BY DEC 31, 2022.  ALL PURCHASES WILL BE UPGRADED TO THE NEW DESIGN AUTOMATICALLY AT NO COST AS SOON AS IT'S READY.