Intake Form

MSP covered by GP referral

Intake Form

Referer: Please download the intake form + fax to client’s GP office.

GP office: Please complete the first section + fax to (604) 677-6119 or fill out the form below.

For GP Office

For Referer

Patient Info

Baby's Info

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Breastfeeding can sometimes come with unexpected hurdles, but you don’t have to face them alone. No matter what you’re experiencing, our caring lactation consultants are here to listen, guide, and help you find solutions that work for you and your baby.

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