Mon–Fri 9AM–5PM · Same-day sick visitsLydia Elias, DO (310) 953-0020 office@lighthousepeds.com Torrance, CA
Lighthouse Pediatrics
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Patient forms

Breastfeeding Questionnaire

About 5 minutes. Your answers help our team prepare for your baby’s feeding or tongue-tie visit.

Step 1 of 7About you and your baby

About you and your baby

We use this to match the questionnaire to your baby’s chart.

Your answers go securely to our clinic and become part of your child’s chart. At the end you can download a PDF copy.

Prefer paper or a PDF?

Your baby

You

A phone number or an email, so we can reach you.