client Thank you for taking the time to fill this out. I will be in touch with you soon to ask a few more in-depth questions to better understand your needs and concerns. I look forward to helping you on your breastfeeding journey!
Name:{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Baby’s Name: {"type":"text","name":"__generic2","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Age/Birth Date:{"type":"text","name":"__generic3","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Today's Date: {"type":"text","name":"__generic4","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Babies Current Weight: {"type":"text","name":"__generic5","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Babies Birth Weight:{"type":"text","name":"__generic6","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Babies Lowest Weight:{"type":"text","name":"__generic7","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Please choose any common concerns that apply:{"type":"radio","name":"__generic8","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please choose one of the above options.","options":"-Nipple pain/Cracking\n-Yeast/Thrush\n-Clogged ducts\n-Mastitis\n-Oversupply\n-Undersupply\n-Breast refusal\n-Discomfort/crying @breast\n-Expressing milk: hand/pump\n-Working & breastfeeding\n-Toddler nursing\n-Weaning\n-Other:"}
{"type":"text","name":"__generic9","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
