Penny Heywood – Classical Homeopath (R.S. Hom) & Lactation Consultant (IBCLC) serving the community of Brockley and South East London
It will be helpful if you can provide the following information as possible prior to an appointment.
Please give details about why you would like a consultation:
Please note any advice to date from your healthcare provider or other breastfeeding support services you may have accessed:
GENERAL MEDICAL BACKGROUND
Are you a smoker? YesNo
Anything else of note:
VaginalAssistedC sectionMedicationComplicationsSkin to skinBreastfeeding after birth
JaundiceInfectionNICUWeightTongue tieRefluxThrushOral abnormalitiesOther
INFANT FEEDING HISTORY
Please give a brief summary of feeding so far including use of bottles, formula, expressing, nipple shield use, and dummies
I give my consent for Penny Heywood (IBCLC) Lactation Consultant to work with me. This includes: observing a complete breastfeed and manual examination of breast and/or examination of baby if necessary. I give my consent to Penny Heywood (IBCLC) Lactation Consultant to share appropriate information with my Healthcare Professionals (Midwife, Health Visitor or GP).
I give my consent to Penny Heywood (IBCLC) Lactation Consultant contacting me by telephone or email in order to provide information and ongoing support.
I have read and understood the above and I give my informed consent for the consultation.