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Intake Forms

Insurance Carrier Required
Select all that appy: Required
Cheif Complaint Required
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Thank you for trusting me to be a part of your breastfeeding experience. This is an honor that I do not take lightly and will strive to provide you with the best care needed throughout your breastfeeding journey. The information provided will not be shared without your consent and only with those individuals specified by you for our continuum of care. Example: Birth Doula, Pediatrician, or your Primary Care Provider.  Please email additional information to: info@RHEcorp.org

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If your health insurance plan is one of the few that isn't required to cover breastfeeding support and counseling, or you're not interested in submitting for reimbursement, you should be aware that home visits from an IBCLC are eligible Health Savings Account (HSA) expenses.  If you have an HSA through your work or your insurance company, you can use your superbill to submit for reimbursement from your HSA funds- you may even be able to use your HSA debit card to pay for the visit.

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Non-refundable deposit retainer (home visits): $75.00 *COVID-19 precautions per CDC, 10 mile radius from downtown Cincinnati 

Non-refundable deposit retainer (virtual visit): $50.00

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