IMPORTANT: Once you submit this document you will receive an email from RightSignature asking you to confirm the document. This form will not be sent to us until you do this.
Consent and Authorization Form
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Our goal is to help each mom achieve success with her nursing choice by providing the FINEST nursing tools and BEST service.
Submit photos of you and your newborn for a chance to be featured on our front page: [email protected]
Email: [email protected]
13783 Ibis St NW Ste 200
Andover, MN 55304
Billing & Insurance
After placing your order and speaking with Milk Moms, you will be directed to fill out this authorization and consent document.
WAIT, READ BELOW FIRST!
Please do not fill out this form if you haven't spoken with Milk Moms yet. If you are inquiring about a pump, please fill out the fast track order form first. We will instruct you when to use the authorization and consent document.
If you have already filled out the fast track order form, or have been instructed to complete the authorization and consent document, please continue below.