Consent For Care for IBCLC Practice

Consent For Care for IBCLC Practice


Need an attorney-reviewed consent form? How about payment policies? This document has both, and also a template for a customer satisfaction survey and language to release your clients when care has concluded.

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What you get:

  • Consent for care, which covers:

    • What typically happens during a lactation visit

    • Permission to send reports to relevant health care providers

    • Acknowledgement that text and email are not secure

    • Permission to share client's address and appointment time with your support person if you do home visits

    • Consent to have others present by express permission of the client, and explanation of how to allow the client to include other people in communications about their care plan

    • Acknowledgement of payment policies and permission to communicate with the client's insurance company (which includes giving a superbill)

    • Permission to take clinical photographs

  • Payment Policies

    • Language for self-pay

    • Language for insurance

  • Client Satisfaction Survey

  • Formal Client Discharge

  • Customizable template taken from the freely available Notice of Privacy Practices on the Health and Human Services Website.

If you purchase these forms, which accompany the ebook Paperless Private Practice for the IBCLC by Annie Frisbie, you may use these forms in your private practice. Please do not share these forms with anyone who has not purchased these forms; the permission granted here is for a single user. These forms are designed for use by IBCLCs; if you have a different credential within the lactation world you may be operating outside of your scope of practice if you use these forms.