Professional Referral for Lactation Consultation I welcome referrals for lactation and parenting support from Health Professionals. Infant's Name* Infant's DOB* Gestational Age at Birth* Mother's Name* Gravida* Para* Partner's Name* Address* Phone* Email* Health Fund* Obstetrician* Paediatrician* Reason for Requesting Consultation* Referred by* Email or Phone of Referring Agent*