This is a sample intake form made available for instructional purposes only for those who have purchased Paperless Private Practice for the IBCLC, the training module for Mobile Lactation Consultant, or the IBCLC Private Practice Essential Toolkit.

This is not a working intake for Annie Frisbie IBCLC, Inc. Any user submissions made through this web page will be deleted without notice. No use of this web page creates or constitutes any relationship between you and Annie Frisbie IBCLC, Inc.

Sample Mobile Lactation Consultant Intake as it can look on your website.

I recommend making the heading say something like “For Current Clients Only. I’ve left the link live so you can see what it will look like to your client when they click the link through to the MLC website.

Thank you for booking an appointment with me. Please fill out my intake forms prior to our visit.

You could add more information here about how clients can prepare for their visit. If your Policies and Procedures require that completing the intake is a requirement to confirm the visit, here’s a good place to repeat that. You may also want to repeat your cancellation policy if you have one.

Please visit the following link from an iPad, iPhone, Android, Mac or Windows PC. The iPad and iPhone are preferred as it allows you to review and sign the consent forms and agreements :

click here to access client portal

If unable to open the client portal from your Mac or Windows computer please follow these steps :

  1. Close all your browsers and try the link again.

  2. Reboot computer and try the link again.

  3. Try a different browser or computer if available.

  4. Even better, if you have access to an iPad or Android please open the link I provided from there.

  5. Enable Silverlight plugin :

    1. Safari - Install Silverlight if you haven't already. Then open the menu Preferences->Websites. Then in left hand column under PLUG-INS, check the box next to Silverlight. This will show a dropdown menu on the right-hand side column labeled "When visiting other websites." Click on the dropdown and select "On.".

    2. Internet Explorer - First be sure there is nothing that says “InPrivate” at the top by the web address. If so, restart your browser. Then press the gear icon in the upper right-hand corner and choose “Manage add-ons”. Then choose “All add-ons” under the “Show:” field. Then scroll down on the right and make sure the “Microsoft Silverlight” add-on is “Enabled”. If on Windows XP use Firefox.

    3. Chrome - Google's Chrome browser does not support Silverlight in version 45 and later. We recommend using Safari or Internet Explorer instead.