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Intake form

Tell me about your breastfeeding — every detail matters

This questionnaire helps me see clearly even before we first meet: it takes about 10 minutes, and at the consultation we can get straight to what matters.

⏱ about 10 min 🔒 GDPR-safe 🗑️ deleted after 5 years 💛 only I can see it
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1. Basic details

The basics, so I know who you are.

This is how I know who the form belongs to until it's linked to an appointment.

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2. Reason for reaching out

The most important part — this helps me the most.

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3. Pregnancy & maternal history

Everything during pregnancy shaped your journey.

Did your breasts change during pregnancy?
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4. Birth details

The circumstances of birth tell a lot about the first days.

Did you get an IV / pain relief during birth?
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5. Baby's details

Your baby's current state, weight and rhythm.

Did jaundice occur? (relevant for babies under one month)
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6. Start of breastfeeding & support

How did your journey together start?

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7. Tools, supplementation, current practice

Every tool counts — no judgment if you use any.

Are any of the following currently used? (multiple can be selected)

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8. Last professional check-up

What have other professionals said so far?

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9. Consent

About the safety of your data.

After submitting, the data is only accessible on Kriszti's admin interface.
The e-mail is just a notification — the full health content is never sent.

Fields marked with * are required.