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Postnatal Client Questionnaire

This form is to help me to get to know you and your family a bit better prior to our session. It helps me to tailor our session specifically to you. There is no pressure to share anything you don’t want to, and all questions are optional except for your contact information.

All responses and information shared during our discussions are strictly confidential and all paperwork including this completed form are kept in accordance with GDPR regulations. Please complete and return this form a minimum of 24 hours before your first session to enable me time to prepare for our time together. If you experience any issues with this form, please email me at info@themilkhub.co.uk

Please email a video of a feed to info@themilkhub.co.uk.  The video shows the position of the breastfeeding parent and baby, the baby latching on, and a close up to show the position of baby’s latch and their suck/swallow pattern.  It is helpful to have someone else film the clip whilst you concentrate on feeding. 

For clients with more than one child, this section relates to the baby you are currently feeding. If you are tandem feeding - amazing! Please detail the names of all the children you are feeding.
As above, if you are feeding more than one child, please include all of their ages in this section.
E.g. husband, wife, partner, friend, parent, etc.
E.g 40 weeks
E.g. If one or both of you were poorly, for example if baby went to NICU.
Things that are helpful here are if you were induced, if you received any medication during labour, and if there were any interventions.
If you would like like to discuss a specific breastfeeding issue, please take a video of baby feeding which includes baby latching onto the breast, and a clear view of baby attached and feeding. Please submit this to me to via email at info@themilkhub.co.uk
Heavy wet means soaked nappies, and dirty means a stool larger than a £2 coin.
E.g. exclusively breastfeeding, exclusively pumping, combi-feeding. Please include as much detail as possible around what a typical feeding day looks like, e.g. how many direct breastfeeds baby is having, and how many bottles
Thank you for taking the time to complete the questionnaire, I know it is quite long! The more detail I have prior to the session means the more time we can focus on tools and techniques for you.