Providers

Vital Milk can provide your patients with a free in-home visit* by Certified Lactation Counselor (CLC) upon delivery of an insurance-covered breast pump. We provide this service to offer evidence-based lactation support and also to help ensure our clients know how to use an electric breast pump properly to establish, maintain and/or increase their milk supply. Upon receipt of this form: Vital Milk will contact your patient, provide information about the different features of each breast pump and schedule their delivery, in-store pick up or shipment. * Our in-home delivery service is currently only available in Hamden, Hampshire and Franklin Counties.

PLEASE SUBMIT YOUR ORDER USING THE FORM BELOW

If you prefer to submit your referral order via fax, you can use downloadable form and fax it to 413-278-2539 or 855-543-8942

All of our forms are HIPAA compliant; please be assured that we have all of the necessary safeguards in place to protect your patient's health information.