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Bellingham Center for Healthy Motherhood Lactation Intake Form MOMS NAME:Main Concerns:Prenatal Care Provider:DOB: Referred by: List all medications, vitamins, herbs and supplements Dose and Frequency
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How to fill out bchm lactation intake form

01
To fill out the BCHM lactation intake form, follow these steps:
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- Begin by entering your personal information such as your name, contact details, and date of birth.
03
- Next, provide details about your pregnancy, including the date of delivery and any complications experienced.
04
- Indicate whether you are breastfeeding your baby or using any other feeding methods.
05
- Answer questions regarding your baby's feeding patterns, including the frequency and duration of feedings.
06
- Provide information about your baby's weight gain and any concerns you may have regarding their growth.
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- Specify any medications or supplements you are currently taking or have taken during lactation.
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- Include information about your breastfeeding goals and any challenges you may be facing.
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- Finally, review all the entered information for accuracy and submit the form.

Who needs bchm lactation intake form?

01
The BCHM lactation intake form is necessary for anyone seeking lactation support or consultation from the BCHM lactation team. This form is typically required for new mothers who are experiencing difficulties or have concerns related to breastfeeding their babies. It helps the lactation consultants assess the individual's unique needs and provide appropriate guidance, recommendations, or interventions to support successful breastfeeding.
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The BCHM lactation intake form is a document used to collect and record information related to the dietary intake and lactation status of breastfeeding individuals.
Individuals who are breastfeeding and participating in relevant programs where lactation intake is monitored are required to file the BCHM lactation intake form.
To fill out the BCHM lactation intake form, individuals must provide personal details, specify their breastfeeding frequency, record dietary intake, and any relevant health information as prompted on the form.
The purpose of the BCHM lactation intake form is to monitor breastfeeding practices, ensure nutritional adequacy, and support maternal and child health.
Information that must be reported includes personal identification details, lactation frequency, type of feeding (breast or formula), and dietary habits or nutritional intake.
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