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

For clients with more than one child, this section relates to the baby or babies you are currently feeding in the case of multiples. 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
Things that are helpful here are if you were induced, if you received any medication during labour, and if there were any interventions.
E.g. If one or both of you were poorly, for example if baby went to NICU.
How your feeding journey has been so far?
Heavy wet means soaked nappies, and dirty means a stool larger than a £2 coin.
E.g. exclusively breastfeeding, exclusively pumping, combi-feeding or exclusively formula 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 for example. We support however you choose to feed.
If you are not breastfeeding, please feel free to skip this question.
E.g. Previous breast surgery, fertility or hormonal concerns, heart conditions, diabetes, tongue-tie or other oral concerns.
For example; Early Help, Perinatal Mental Health, Childrens Social Care, Home Start, Your Family, Infant Feeding Team etc.
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.
You will be asked to confirm the above information again, the day before your appointment. In the event of one or more of the above conditions not being met, a face-to-face appointment will not be able to take place. A virtual appointment will be offered to you at the same time.