Schedule your First Appointment

You may have a visiting professional present to shadow your IBCLC during your appointment. You have the right to refuse an additional provider in the room. Verbal consent will be requested at the start of your appointment; please let your IBCLC know immediately if this is not something you are comfortable with.

To request your first appointment with WNY Orofacial & the Breastfeeding Support Center, please complete the form below.

* Indicates required field

Your Name *

First

Last

Phone Number *

Can this number receive texts? *

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Email *

Your Child's Name *

First

Last

Child's Date of Birth *

Reason for the Appointment *

I understand that my confirmation email may be directed to my spam folder unless I enter Mary@WNYOrofacial to my contact list. I will ensure to check my spam folder for my confirmation email if I am concerned that I have not yet heard back. *

I understand

I understand that complex feeding challenges commonly take time to resolve, that revisions to my Individualized Care Plan are commonly appropriate and necessary and that frequent communication of concerns, questions, and progress between me and my IBCLC facilitate the best likelihood of success in achieving my goals. To that end, I am responsible for informing my IBCLC of any relevant information or changes that may affect my baby's feeding situation. *

I understand

How did you hear about us? *

Upon clicking the submit button below, your information will be directed to our admin team for entry into our online scheduling system. You will be redirected to a confirmation page with instructions for your next steps. Thank you for choosing WNY Orofacial & Breastfeeding Support Center!

I agree to receiving marketing and promotional materials

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