Lactation Consultation or Information Request

Please fill out this form or call Alisa directly at 618-406-6372.

Home visits are available within 30 miles of downtown Edwardsville, IL. Otherwise, you may schedule an office visit that will take place at 201 Hillsboro Avenue, Edwardsville, IL.

Name

First Name

Last Name

Birth or Due Date of Baby/Babies

When is your due date or when was your baby born?

YYYY

Phone

(###)

###

####

Email Address

Subject

Message

Please explain your current or anticipated challenges with breastfeeding.

Consultation Location Preference

Where would you like to receive consultation. If in home, please add your address to the form below.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Request a Lactation Consult

Lactation Consultation or Information Request