Consent for Care
This Consent for Care form must be signed before our first appointment. It outlines the understanding and agreement between you ("Client") and myself ("Consultant"), regarding lactation support services provided.
1. Purpose of Services
The purpose of lactation consultation services is to support the Client in meeting their infant feeding goals through education, guidance, and hands-on or virtual support. Services may include observation of feeding, assessment of latch and positioning, education on pumping or bottle feeding, creation of a care plan, and referrals when appropriate.
2. Voluntary Participation
I understand that my participation in lactation consultation services is voluntary and that I may decline any aspect of care or discontinue services at any time without affecting my relationship with my healthcare provider or insurance benefits.
3. Client Responsibilities
I agree to:
Provide accurate and complete health and feeding history for myself and my child.
Communicate openly with Consultant about my goals, concerns, and any changes in health status.
Follow through with the agreed-upon care plan to the best of my ability and seek further medical advice if needed.
4. Consultant Responsibilities
Miranda Byrd, Consulting Lactation Nurse, agrees to:
Deliver services within the scope of an International Board-Certified Lactation Consultant (IBCLC).
Maintain a safe, supportive, and respectful environment.
Provide evidence-based recommendations and refer to appropriate providers when needs exceed the IBCLC scope of practice.
5. Risks and Limitations
I understand that:
There are no guaranteed outcomes, and some difficulties may persist despite best efforts.
Consultant does not diagnose or treat medical conditions and will refer to medical providers when necessary.
Telehealth consultations may have limitations due to the inability to perform hands-on assessments.
6. Consent to Services
By signing below, I confirm that:
I have read and understood this Consent for Care.
I have had the opportunity to ask questions.
I consent to receive lactation support services from Miranda Byrd, Consulting Lactation Nurse, either in person or via telehealth.
