Milk Donor Screening Request
We are so excited to talk with you! Many families are reaching out to donate milk, which is wonderful. We are doing our very best to respond to screening requests and will be in touch as soon as possible, Thank you for your understanding.
Today's Date
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Month
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Day
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Name
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First Name
Last Name
Phone Number
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E-mail
Are you donating after a loss (bereavement)?
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Yes
No
Date of baby's birth
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Month
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Day
Year
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Do you have 100 or more ounces of milk for a recommended initial donation?
YES
NO
NOT SURE
Age of the milk/storage time?
Who can we thank for referring you to NWMMB?
Additional comments or questions.
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