Lactation Consultation Terms of Service, Confidentiality & Consent Form
By reading and acknowledging this Terms of Service, you give the following consent, and agree to the terms in this document.
Welcome to my practice. This document confirms the consultant services to be provided by Mayvina Wee, International Board Certified Lactation Consultant (IBCLC, L-316468), from Manna Milk Lactation (subsidiary of Yummies4mummies Ptd Ltd) to you, the ("Client”).
Although these documents are long and sometimes complex, it is very important that you read them carefully before our next appointment. We can discuss any questions you have about the procedures at that time. When you sign this document, you give the following consent, and agree to the terms in this document. It will also represent an agreement between us.
This document outlines the terms and conditions between the Lactation Consultant ("Consultant") and the Client ("Client") for the provision of lactation consultation services. The role of the Consultant is to assist breastfeeding parents in achieving optimal breastfeeding outcomes by providing education, support, and guidance before, during, and after the breastfeeding process. The Consultant offers expertise in breastfeeding techniques such as positioning, latch, and infant feeding habits, and addresses challenges that may arise, including low milk supply, weight concerns, or other issues.
This document is designed to ensure clear communication and mutual understanding of the services to be provided, the responsibilities of both parties, and the expectations regarding payment, confidentiality, and other terms. By signing this Agreement, the Client acknowledges that they have read, understood, and agreed to the terms and conditions outlined herein.
Scope of Services
The Lactation Consultant agrees to provide professional lactation consultation services to the Client to support breastfeeding and infant feeding goals. These services may include, but are not limited to, the following:
Initial Consultation:
The initial consultation includes a thorough assessment of the breastfeeding process, including the baby’s latch, positioning, and feeding habits, as well as the Client’s breast health. The Consultant will provide personalized advice and recommendations to address any breastfeeding concerns, such as low milk supply, nipple pain, or feeding difficulties.
Follow Up Consultations:
I understand a partial or follow-up consultation is sometimes necessary. Follow-up consultations are provided to monitor progress, adjust strategies as needed, and continue supporting the breastfeeding process. These visits may be conducted in person or virtually, depending on the Client’s needs and preferences.
Prenatal Support:
Prenatal consultations are available to educate expecting parents on breastfeeding basics, prepare for breastfeeding success, and create a plan for the early days postpartum. These consultations may cover topics such as milk production, infant feeding cues, and establishing a comfortable breastfeeding routine.
Postpartum Support:
Prenatal consultations are available to educate expecting parents on breastfeeding basics, prepare for breastfeeding success, and create a plan for the early days postpartum. These consultations may cover topics such as milk production, infant feeding cues, and establishing a comfortable breastfeeding routine.
Phone/Text Support:
The Client is entitled to phone and text support for the duration of the Consultant’s services and one month after the last consultation session. The Consultant will respond to questions and concerns related to breastfeeding and infant feeding as promptly as possible. This support is designed to offer guidance and reassurance between scheduled visits.
The Consultant does not provide medical advice or replace care provided by a physician. All advice and recommendations are offered within the Consultant’s scope of practice as an International Board Certified Lactation Consultant (IBCLC).
Client's Responsibilities
Accurate Information:
The Client is responsible for providing accurate and complete information regarding their medical history, breastfeeding goals, and any concerns related to breastfeeding or infant feeding. This includes any relevant health information about both the Client and the baby that may affect breastfeeding outcomes.
Timely Communication:
The Client agrees to communicate with the Lactation Consultant in a timely manner regarding any changes in their breastfeeding journey or health status. This includes reporting progress, challenges, or any new concerns that arise during the course of care. If follow-up support is needed, the Client is responsible for initiating contact as agreed upon in the consultation plan. Email/phone contact during the two weeks following the consultation is crucial and considered an extension of this visit.
Consultation Environment:
For in-home consultations, the Client agrees to provide a safe and clean environment for the Consultant to work in. It is recommended that a quiet space is available for the assessment and consultation to take place, minimizing distractions to ensure the best possible support.
Follow Recommendations:
The Client agrees to consider the recommendations provided by the Consultant and to implement any mutually agreed-upon strategies for improving breastfeeding outcomes. The Client understands that success may depend on their adherence to these recommendations and their willingness to communicate concerns as they arise.
Primary Healthcare Provider:
The Client understands that the Lactation Consultant’s services do not replace medical care and agrees to consult their primary healthcare provider or pediatrician regarding any medical concerns about their health or their baby’s health. The Client agrees to inform the Consultant if there are any significant changes to their care plan made by their healthcare provider.
Fees
Fees & Payment:
The Client agrees to pay the fees associated with lactation consulting services as outlined in the Consultant’s current fee schedule. Fees are subject to change with appropriate notice provided to the Client prior to scheduling services. All services provided, including in-person consultations, virtual consultations, and any follow-up support, are billed according to the rates communicated to the Client at the time of booking.
Single consultation: $50 pre-payment is required to secure the slot.
4th Trimester Support: $100 pre-payment is required to secure the slots. You may prebook both slots.
Payment must be made within 24 hours of appointment confirmation.
Extended consultation (above 2 hours) will be charged at SGD 20 per every 10 minutes, subjected to availability. Payment must made after the consultation.
Payment Terms:
Full payment is due prior to the date of the consultation or at the time of receiving an invoice, unless otherwise agreed upon in writing by both parties. The Client is responsible for ensuring payment is made through the accepted payment methods outlined by the Consultant. All services are subject to applicable sales tax, which will be reflected in the Client’s invoice. The Client agrees to pay any and all sales taxes as required by law.
Travel Fees:
A travel fee of $10 to $30 will be added to the total invoice to cover the Consultant’s travel expenses. Any travel fees will be disclosed at the time of booking and reflected in the final invoice.
Cancellations and Termination
Client Cancellations:
The Client agrees to provide a minimum of 4 hours' notice for canceling or rescheduling an appointment. Please call or WhatsApp 8705 6039. Failure to provide 4 hours' notice will result in forfeit of the deposit. Appointments canceled with at least 4 hours' notice will receive a full refund or the option to reschedule without penalty.
Consultant's Cancellations:
In the event that the Consultant needs to cancel or reschedule an appointment due to unforeseen circumstances, the Client will be offered the option to reschedule or receive a full refund for any prepaid fees. The Consultant will make every effort to provide as much advance notice as possible in the case of a cancellation or rescheduling.
Privacy & Confidentiality
The Consultant is committed to maintaining the strictest confidentiality in all interactions with the Client(s). All personal, medical, and family information shared during the course of the Consultant-Client relationship will be treated as confidential and will not be disclosed to any third parties without the express written consent of the Client(s), except where disclosure is required by law.
This includes, but is not limited to:
Personal and medical information shared during prenatal, labor, and postpartum support
Information regarding the Client(s)'s family, household, or support network
Any conversations, written communications, or documentation exchanged between the Consultant and the Client(s)
Exceptions to Confidentiality:
While confidentiality is a priority, there are certain circumstances in which the Consultant may be legally required to disclose information without the Client(s)'s consent. These circumstances include, but are not limited to:
- Suspected child abuse or neglect
- Imminent risk of harm to the Client(s), their baby, or others
- Court orders, subpoenas, or legal proceedings mandating the disclosure of specific information
In such cases, the Consultant will make reasonable efforts to inform the Client(s) of the necessity to disclose the information unless legally prohibited from doing so.
Testimonials & Feedback:
Client(s) may choose to provide feedback, testimonials, or reviews regarding the services received. Such information will only be shared publicly with the explicit written consent of the Client(s). Testimonials will not include the Client’s name, likeness, or identifying information.
Dispute Resolution
Dispute Resolution:
In the event of any dispute, claim, or disagreement arising out of or related to this Agreement, the Client(s) and Consultant agree to first attempt to resolve the matter through good faith negotiation. Both parties commit to communicating openly and honestly in order to reach a mutually acceptable solution.
If a resolution cannot be reached through negotiation, the dispute shall be submitted to mediation with a neutral third-party mediator, agreed upon by both parties, in the locality where the services were rendered. The costs of mediation will be shared equally between the Client(s) and Consultant, unless otherwise agreed upon.
If mediation does not resolve the dispute, the parties may pursue legal remedies available under the laws of the province or country in which the services were performed. However, both parties agree that litigation should be the last resort and will seek to avoid court proceedings whenever possible.
Governing Law:
This Agreement shall be governed by and construed in accordance with the laws of the Republic of Singapore, where the services are performed without regard to conflict of law principles. Any legal action brought by either party in connection with this Agreement shall be filed in a court of competent jurisdiction within that province or jurisdiction.
Thank you for reading through this document and we thank you for trusting us with your breastfeeding journey.
Last updated on 6 March 2025. Manna Milk reserves the right to update this consent form without any prior notice.