Office Name and Address:

Office Phone:

Office Fax:

Email:

Topics:
Alternate Feeding Methods
Anatomy and Physiology of Breastfeeding
Ankyloglossia
Benefits of Breastfeeding
Breastfeeding and Maternal Infection
Breastfeeding, Drugs and Medications
Breastfeeding Doodads: Pumps, Pillows and Potions
Contraindications to Breastfeeding
Donor Human Milk
Early Breastfeeding Management
Jaundice and Breastfeeding
Maternal Problems: Sore Nipples and Mastitis
Nursing Multiples
Prenatal Breastfeeding Risk Assessment
Supplementation
The Baby Friendly Hospital Initiative
The Borderline Preemie (34 to 37 weeks)
The Breastfeeding Friendly Office
Working and Breastfeeding
Other topics:

Preferred Length (Total with Q&A):
20 Minutes
30 Minutes
45 Minutes
60 Minutes
Other Length:

Preferred Time:
Before Office Hours: (specify time):
Lunchtime: (specify time):
After Hours: (specify time):
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Preferred Format: Lecture/Discussion/Q&A
Computer Projected (PowerPoint)
Computer Screen (PowerPoint)
Handouts Only

Approximate Number of Participants:

Comments or Questions: