Free Lactation Consultant Contract Template (2024 Updated)

This template is designed to cover essential aspects of a lactation consultant agreement. Depending on specific needs and circumstances, it may require further customization. It's also advisable to have any contract reviewed by a legal professional.

Lactation Consultant Services Agreement

This Agreement is made and entered into as of [Date], by and between:

Client: [Client's Full Name]
[Client's Address]
[City, State, ZIP Code]
[Phone Number]
[Email Address]

Lactation Consultant: [Consultant's Full Name]
[Consultant's Business Name]
[Consultant's Address]
[City, State, ZIP Code]
[Phone Number]
[Email Address]

1. Services Provided

The Lactation Consultant agrees to provide the following services:

• Initial consultation, including assessment of breastfeeding issues, latch evaluation, and personalized feeding plan.
• Follow-up consultations as needed.
• Email or phone support for a specified period following consultations.
• Education and guidance on breastfeeding techniques, positions, and infant nutrition.
• Assistance with breastfeeding equipment and supplies.

2. Fees and Payment

• Initial Consultation Fee: $[Amount]
• Follow-up Consultation Fee: $[Amount]
• Phone/Email Support: $[Amount] (if applicable)
• Payment is due at the time of service unless otherwise agreed in writing.
• Accepted payment methods: [List payment methods, e.g., cash, check, credit card, etc.]

3. Insurance and Reimbursement

• The Lactation Consultant does not bill insurance companies directly.
• The Client is responsible for seeking reimbursement from their insurance provider.
• The Consultant will provide necessary documentation for reimbursement purposes upon request.

4. Cancellation Policy

• Appointments must be canceled at least [Time Frame, e.g., 24 hours] in advance.
• Cancellations made within [Time Frame] will incur a cancellation fee of $[Amount].
• No-shows will be charged the full consultation fee.

5. Confidentiality

• All client information will be kept confidential and only shared with healthcare providers as necessary with the client's consent.
• The Lactation Consultant complies with HIPAA regulations regarding the protection of health information.

6. Limitation of Liability

• The Client understands that the Lactation Consultant is not a medical doctor and that services provided are not a substitute for medical care.
• The Consultant shall not be liable for any injury or harm resulting from advice or services provided.

7. Client Responsibilities

• The Client agrees to provide accurate and complete health information to the Lactation Consultant.
• The Client agrees to follow the advice and recommendations provided to the best of their ability.
• The Client understands the importance of seeking medical advice for any health concerns that may arise.

8. Termination

• Either party may terminate this agreement at any time with written notice.
• The Client remains responsible for payment of services rendered prior to termination.

9. Governing Law

• This Agreement shall be governed by and construed in accordance with the laws of the State of [State].

10. Entire Agreement

• This Agreement constitutes the entire understanding between the parties and supersedes all prior agreements, understandings, and negotiations.

11. Amendments

• Any amendments to this Agreement must be in writing and signed by both parties.

Signatures

Client: ___________________________ Date: ___________

Lactation Consultant: ___________________________ Date: ___________