Patient Consent Policy

Wildflower Health, Inc.

I give my consent for the designated International Board Certified Lactation Consultant from Wildflower Health to evaluate and recommend a care plan for me and my baby during this consultation for my breastfeeding/chestfeeding concerns.

A lactation consultation with Wildflower Health may be in-person or virtual based upon your chosen appointment. It will include a history and/or exam of mother and infant, assessment of anatomy, and effectiveness of feeding. 

I give my consent to release any information acquired during this evaluation and consultation to my baby's and my primary health care provider, referring physicians, referring lay counselors, and/or insurance company.

I understand that my visit will be covered 100% by Cigna with no cost sharing and I give my consent for the Wildflower Health and the lactation consultant to release pertinent information to my insurance company, as necessary.

This consent is for today's visit and future visits - phone or video conversations, texts, information sent by email, fax, or regular mail. I understand that text messages and emails may not be private or encrypted. If I choose to communicate via text or email, I am doing so with this understanding and with my consent.

I understand that an in-home lactation consultation may involve:

• touching my breasts and/or nipples for the purposes of assessment inserting a finger or pacifier into my baby's mouth to assess suck

• observation of a breastfeed, and suggestions to enhance latch or position

• demonstration of the use of equipment or supplies that may be recommended demonstration of 

• techniques designed to improve breastfeeding

I give my consent for the lactation consultant to use clinical information obtained during our sessions for educational purposes. You will not be identified in any way, but aspects of my situation may be described and discussed.

I understand that a telehealth consultation may involve potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. 

I understand that my provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

I understand Wildflower Health does not provide any emergency or urgent medical services. In the event of an emergency, I will call 911. 

I understand that from time to time, Wildflower Health may reach out directly to me to collect feedback as we continuously try to improve our customer experience. 

I understand that for this lactation consultation and all follow-up, the lactation consultant will protect the privacy of my personal health information as required by the Code of Ethics of the International Board of Lactation Consultant Examiners, the Standards of Practice of the International Lactation Consultant Association, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).