Patient Consent & Cancellation Policy
Simply Lactation
Last Updated: May 2026
1. Consent to Lactation Services
By booking or participating in services with Simply Lactation, I consent to receive lactation consultation and related support services. These services may include assessment, education, care planning, breastfeeding support, pumping guidance, infant feeding support, follow-up communication, and related recommendations.
I understand that lactation services are intended to support breastfeeding, pumping, infant feeding, and related concerns, but they do not replace medical care from a physician, pediatrician, OB/GYN, midwife, or other qualified healthcare provider.
2. No Emergency Services
I understand that Simply Lactation does not provide emergency medical services. If I or my baby are experiencing a medical emergency, I should call 911 or seek immediate medical care.
I understand that urgent concerns such as fever, dehydration, poor feeding, breathing difficulty, severe pain, signs of infection, jaundice, low diaper output, lethargy, or any other serious medical concern should be addressed by a qualified medical provider immediately.
3. Medical Care and Referrals
I understand that Simply Lactation may recommend that I contact my physician, pediatrician, OB/GYN, midwife, dentist, speech therapist, occupational therapist, or another healthcare professional when additional evaluation or treatment is needed.
I understand that I am responsible for seeking appropriate medical care for myself and my baby and for following up with medical providers as recommended.
4. Client Responsibility to Provide Accurate Information
I agree to provide accurate, complete, and current information about myself and my baby, including health history, feeding history, medications, allergies, birth history, infant weight concerns, medical conditions, prior procedures, insurance information, and any other information relevant to lactation care.
I understand that inaccurate, incomplete, or withheld information may affect the quality of recommendations and services provided.
5. Consent for Parent, Baby, and Family Information
I understand that lactation services may involve collecting and discussing personal and health-related information about me, my baby, and, where relevant, other family members or caregivers involved in feeding support.
By providing information about my baby or another family member, I confirm that I am authorized to provide that information.
6. In-Home Visit Consent
If I schedule an in-home visit, I consent to a Simply Lactation provider entering my home or requested service location for the purpose of providing lactation services.
I agree to provide a safe, clean, and accessible environment for the visit. I agree to provide accurate address details, parking instructions, gate codes, pet information, and any other information needed for the provider to safely complete the appointment.
I understand that Simply Lactation may cancel, reschedule, or discontinue an in-home visit if the provider determines that the environment is unsafe, inaccessible, inappropriate, or outside the confirmed service area.
7. Virtual Visit and Telehealth Consent
If I schedule a virtual consultation, I consent to receiving lactation support through video, phone, or other electronic communication methods.
I understand that virtual consultations have limitations because the provider is not physically present and may not be able to perform the same level of observation or support as an in-person visit.
I understand that technology issues, internet interruptions, audio/video quality, privacy limitations, or incomplete visual assessment may affect the consultation.
I agree to participate in virtual consultations from a private and safe location and to use a device and internet connection that allow the consultation to be conducted appropriately.
8. Consent to Communication
I consent to being contacted by Simply Lactation by phone, email, text message, WhatsApp, or other communication methods for appointment scheduling, intake, care coordination, follow-up support, reminders, billing, insurance-related matters, and service-related communication.
I understand that email, text messages, WhatsApp, and other electronic communication methods may not be fully secure. I understand that there may be risks to sending health-related information through these channels.
I may request that Simply Lactation limit non-essential communications, but I understand that important appointment-related, billing-related, legal, or care-related communications may still be necessary.
9. Consent to Use and Disclosure of Information
I consent to Simply Lactation collecting, using, and maintaining personal and health-related information as necessary to provide services, manage appointments, coordinate care, process billing or insurance-related matters, maintain records, communicate with me, and comply with legal or professional obligations.
I understand that Simply Lactation may share information with healthcare providers, insurance-related service providers, billing platforms, scheduling platforms, payment processors, administrative service providers, or other parties as needed to provide services or as permitted or required by law.
10. Insurance and Payment Responsibility
I understand that insurance coverage, eligibility, reimbursement, and benefit details are not guaranteed. Insurance benefits may vary based on my plan, provider network, deductible, coverage limits, documentation requirements, and other factors.
I agree to provide accurate insurance information, if applicable. I understand that I may be responsible for any amounts not covered, denied, reimbursed, or paid by insurance, unless otherwise required by law or agreed in writing.
I understand that payment may be required before, during, or after the appointment depending on the service, insurance status, and billing process.
11. Cancellation Policy
Appointments require provider time, scheduling, travel planning, and preparation. If I need to cancel an appointment, I agree to provide at least 24 hours’ notice.
If I cancel with less than 24 hours’ notice, I understand that a cancellation fee of $50 may apply.
12. No-Show Policy
If I am unavailable for my appointment, fail to attend a virtual visit, do not answer at the scheduled time, provide an incorrect address, or prevent the provider from completing the appointment, the appointment may be treated as a no-show.
I understand that no-shows may be subject to a $50 fee or the full appointment fee, depending on the appointment type, provider travel, and circumstances.
13. Late Arrival or Delayed Start
If I am late or unavailable at the scheduled appointment time, the appointment may be shortened, rescheduled, or treated as a no-show depending on provider availability and the amount of delay.
I understand that appointment fees may still apply if the consultation time is reduced due to my delay or unavailability.
14. Provider Cancellation or Service Changes
Simply Lactation may need to cancel or modify an appointment due to provider illness, emergency, unsafe conditions, weather, travel issues, incomplete intake information, service area limitations, or other circumstances beyond our control.
If Simply Lactation cancels an appointment, we will make reasonable efforts to notify me and offer available options where appropriate.
15. Follow-Up Communication
Follow-up communication may be provided as part of the service when appropriate. The amount, timing, and method of follow-up may vary based on the appointment type, care plan, provider availability, and service terms.
I understand that follow-up communication is not for emergencies and may not be reviewed in real time.
16. Photography, Video, and Recording
I understand that I should not record, photograph, or share any consultation without prior permission from Simply Lactation and any other individuals involved.
Simply Lactation will not use photos, videos, testimonials, or identifying information for marketing purposes without appropriate consent.
17. Acknowledgment of Risks and Limitations
I understand that lactation consultation is based on the information available at the time of the visit and that recommendations may need to change based on my baby’s health, my health, feeding response, medical evaluation, or other factors.
I understand that Simply Lactation cannot guarantee specific results, including milk supply, latch improvement, feeding outcomes, symptom relief, insurance coverage, or reimbursement.
18. Agreement to Policies
By booking an appointment, submitting intake forms, signing this policy, checking an agreement box, or participating in services, I confirm that I have read, understood, and agree to this Patient Consent & Cancellation Policy.
I also acknowledge that my use of Simply Lactation’s website and services may be subject to the Privacy Policy and Terms & Conditions.
19. Contact Information
If you have questions about this Patient Consent & Cancellation Policy, please contact us:
Simply Lactation
Email: info@simplylactation.com
Phone: 832-566-8949
Website: simplylactation.com
