Online sign-up form

If you have a non-urgent breastfeeding question or concern, or would like to be assigned to a breastfeeding counselor ahead of your due date, please fill out the online form and someone will be in touch with next steps within 24-48 hours.

Your name *
Your name
Your partner's name (if applicable)
Your partner's name (if applicable)
Phone *
Phone
If you do not live in one of the counties listed, chose "other." We counsel worldwide!
Due date or Delivery date *
Due date or Delivery date
Preferred language
If you would prefer support in a language other than English, please complete this section.
Preferred contact method *
Please select one option
How did you hear about us?
Please let us know how you found Nursing Mothers Counsel.
Please let us know what your inquiry is regarding so we can best route you to the right help!