Preparing for The Fourth Trimester Questionnaire

This form is to help me get to know you and your family a bit better. There is no pressure to share anything you don’t want to, and all questions are optional except for 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

E.g. husband, wife, partner, friend, parent, etc.
This information helps shape my support. For example, if you are at high risk for pre-term labour, the strategies owe discuss may be different from someone with gestational diabetes.
i.e. breast/chest feeding, formula feeding, expressing or combination feeding.
If this is your first baby, feel free to skip this section.
For example; Early Help, Perinatal Mental Health, Childrens Social Care, Home Start, Your Family, Infant Feeding Team etc.
E.g. Previous breast surgery, fertility or hormonal concerns, heart conditions, diabetes, tongue-tie or other oral concerns.
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 support and information for you.