Consent to Care

I give my permission to Suckle and Spritz Lactation to treat me and my baby. This includes observing breastfeeding sessions, evaluating latch and positioning, providing hands-on assistance or evaluation of the breasts if necessary, evaluation of baby’s mouth, demonstration of techniques and creation of feeding plans.

I acknowledge Suckle and Spritz Lactation consultant will provide a suggested treatment plan to the best of their skill and knowledge, developed collaboratively with me to meet my feeding goals.

I acknowledge results may vary based on variations in anatomy, individual health factors and adherence to treatment plans.

I will be in timely communication with the Suckle and Spritz Lactation consultant if issues should arise that I would like to be treated and addressed by them.

The information I provide is correct and true to the best of my knowledge.

I understand that if approved by The Lactation Network, services rendered by Suckle and Spritz will be covered by them fully, as stated in any communications between myself, TLN, and Suckle and Spritz.

I understand that any Explanation of Benefits is NOT A BILL and TLN Explanations of Benefits are not reflective of the rates charged by Suckle and Spritz lactation, nor indicate the amount of patient responsibility (which is $0).

I understand that if using self-pay, Suckle and Spritz Lactation payments are due at the time of booking and a super-bill will be provided within 48 hours of services rendered for the purpose of submission to insurance.