First time clients please submit the following intake/referral form, yourself or your healthcare provider.
If you are a current client please email for followup as opposed to calling. I also work on-call as a midwife and I could be on call (but sleeping!) after a long labour - thank you!
INTAKE/REFERRAL FOR LACTATION SUPPORT
Mercer Wilcock, RM, IBCLC
London Lactation Clinic
774 Wellington St. London, ON N6A 3S3
www.londonlactationclinic.com
info@londonlactationclinic.com
647 762 7235
All information asked is essential to a competent, efficient assessment - thank you
To be completed as the client self-referring or healthcare provider referral