Request A Lactation Consultation | - The Lactation Network

Hi, we’re The Lactation Network, or TLN for short!

We’ll check your insurance coverage and then pair you with an expert lactation consultant, also known as an IBCLC. We partner with a network of hundreds of IBCLC groups and private practices.

If you already know which consultant or group you would like to see, please let us know, otherwise our team will pair you with an IBCLC that’s just right for you!

If you have any questions on how to fill out the form please email us at care@tln.care or call (888) 510-0059.

Tell us your pairing preference:*

I would like the TLN team to pair me with an IBCLC!
I already have an IBCLC that I’d like to be paired with

Please indicate your preference of COVID-19 vaccination status:*

I prefer to be paired with an IBCLC who is fully vaccinated
I do not have a preference on the vaccination status of my IBCLC

Note: To be fully vaccinated with the Johnson & Johnson single dose vaccine the IBCLC must be at least two weeks past the administration of the shot. To be fully vaccinated with either the Moderna or Pfizer two dose vaccines, the IBCLC must be at least two weeks past the second dose of the vaccine.

Consultant Name*

Consultant Name

COVID-19 Vaccination Acknowledgement*

I understand that TLN’s pairing selection is based on information provided to it by the consultants, but that TLN does not independently verify vaccination status. Therefore, by checking this box, I understand that it is my responsibility to discuss and verify vaccination status with my consultant and I accept full responsibility for doing so.

How urgent is your need for a visit?*

Emergent - need to be seen in the next 36 hours
Urgent - need to be seen within the next 72 hours
Non-Urgent - can wait 5 days for a visit
Planning ahead - can wait more than 5 days for a visit

Which type of visit do you prefer?*

In home
In office
Telehealth
No preference

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should visit type field be hidden?

yes

Lactating Parent's Name*

First Last

Preferred Name

Lactating Parent’s Email Address*

Lactating Parent’s Email Address

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Lactating Parent’s Mobile Phone*

Lactating Parent’s Mobile Phone

Lactating Parent’s Date of Birth*

Lactating Parent’s Date of Birth

Lactating Parent's Home Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Lactating Parent's Primary Insurance Provider*

Lactating Parent's Primary Insurance Provider

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Lactating Parent's Primary Insurance Provider - Name

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Lactating Parent's Primary Insurance Provider - Id

Lactating Parent's Primary Insurance Policy Number (with prefix, no spaces)*

Lactating Parent's Primary Insurance Policy Number (with prefix, no spaces)

Lactating Parent's Primary Group Number (with prefix, if applicable)*

Lactating Parent's Primary Group Number (with prefix, if applicable)

Employer*

Employer

If this insurance is provided by yours or a family member's employer organization, please type the name of the employer below. (Some employers may populate for you once you begin typing. If so, please select the employer that matches. If the employer’s name does not populate, that’s okay, continue entering the employer organization.) If this insurance is not provided by an employer organization (i.e., Medicaid, Insurance Marketplace, etc.) please type ‘None.’

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Employer Source for Search

Lactating Parent’s Insurance Card - Front*

Please upload the front photo of your insurance card

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB, Max. files: 1.

Lactating Parent’s Insurance Card - Back*

Please upload the back photo of your insurance card

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB, Max. files: 1.

Relationship to Subscriber*

Relationship to Subscriber

Subscriber Name*

First Last

Subscriber Date of Birth*

Subscriber Date of Birth

Do you have a secondary insurance plan?*

Do you have a secondary insurance plan?

Secondary Insurance Provider*

Secondary Insurance Provider

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Secondary Insurance Provider - Name

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Secondary Insurance Provider - Id

Secondary Insurance Policy Number*

Secondary Insurance Policy Number

Secondary Group Number*

Secondary Group Number

Secondary Insurance Card - Front*

Please upload the front photo of your insurance card

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB, Max. files: 1.

Secondary Insurance Card - Back*

Please upload the back photo of your insurance card

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB, Max. files: 1.

REQUEST A CONSULTATION

Requesting a consultation with:

Lactating Parent's Insurance Information

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REQUEST A CONSULTATION

Requesting a consultation with:

Check my Coverage

Lactating Parent's Insurance Information

Has your baby arrived?