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Mama's Milk Wrap
Proven Non-Ingestible Breastfeeding Aid
How It Works
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How It Works
Lactation Consultant Application
Phone Number - Cell
Phone Number - Business
Address Line 2
State / Province / Region
ZIP / Postal Code
Antigua and Barbuda
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Congo, Democratic Republic of the
Congo, Republic of the
French Southern Territories
Heard and McDonald Islands
Isle of Man
Lao People's Democratic Republic
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Svalbard and Jan Mayen Islands
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
US Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Means of Service
This bio will be visible to our community of Mamas.
Upload your Headshot
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Accepted file types: jpg, jpeg, png.
This headshot will be visible to our community of Mamas. Maximum of 2 files. Accepted in jpg, jpeg, or png file formats.
Upload your Current License and/or Certification
Drop files here or
Accepted file types: jpg, jpeg, pdf.
Maximum of 4 files. Accepted in jpg, jpeg, or pdf file format.
Lactation Consultant Agreement
Lactation Consultant (“Consultant”)
enters into this agreement with Mama’s Milk Wrap (“Company”) and agrees to provide a one-time (first) lactation consultation session, at no charge, to a purchaser of a Mama’s Milk Wrap product (“Product”) in exchange for Company website publishing Consultant’s biography and contact information for the benefit of Purchasers.
Upon every purchase of a new Product, the Purchaser will be given a voucher/coupon code for a one-time consultation with a licensed lactation consultant. Purchasers will have access to information of qualified Consultants on the Company’s website. To be qualified and be included as a qualified Consultant, the following must be agreed to:
1. Consultant agrees to provide; proof of education in lactation consultation (certificate and/or diploma) and submit to criminal background check.
2. Consultant agrees to provide all information necessary and submit to a background check at the request of Company.
3. Consultant agrees no form of compensation other than the website referral will be received from Company.
4. Consultant agrees to provide a professional biography and give Company permission to publish, alter (format), edit (grammar, syntax, style, etc.), or remove the biography from Company’s website. Any objection or request for changes to biography by Consultant must be submitted via email.
5. Consultant agrees to be responsible for promptly scheduling the one-time free consultation to Purchasers. Consultation service must be performed within two weeks of the time requested by the Purchaser.
6. Consultant agrees to offer the option of an on-the-phone, video conference, or in-person consultation, at the discretion and choice of the Consultant.
7. Consultant agrees to verify the consultation code with Company.
8. Consultant agrees to provide Company with date and time of all scheduled appointments where consultation code will be redeemed.
9. Consultant agrees to only accept one voucher per Product purchase.
10. Consultant agrees that Company has the right to choose or not choose Consultants as well as remove Consultant from its list of qualified Consultants for any reason, including but not limited to the failure to provide the listed information, materials, or quality of service rewarded to Purchaser.
11. Consultant has the right to immediate termination of this agreement for any reason, however Consultant’s committed (scheduled) consultation sessions must be honored per
12. Consultant agrees to make Company aware (in written correspondence) of any complaint, reprimand, or disciplinary action filed with or made by a licensing board, employer, or patient (without violating privacy laws of the patient).
13. Consultant agrees that a follow-up review will be requested of all Purchasers regarding the services provided by Consultant.
14. Consultant agrees that Company is not responsible for any actions of Consultant within and without the professional or consultant relationship with Purchasers.
15. Consultant agrees that Company is not responsible for any actions of Purchaser within and without the professional or consultant relationship with Purchasers.
16. Consultant agrees that any disputes arising out of the terms of this agreement are to be governed under the laws of the State of Oklahoma and that any actions involving this
agreement are under the exclusive jurisdiction of the District Court of Bryan County, Oklahoma.
By checking this box, the Consultant agrees to the preceding paragraphs and enters into this binding agreement.
Type Full Name
This field acts as your signature.
Date Format: MM slash DD slash YYYY
I understand and agree.
By checking this box I am acknowledging that I understand and agree to use Good Hire for my background check verification.
In order, for this network to be sustainable, we need each consultant to cover the background check expense of approximately $25 (some locations may vary).
Please use this link to complete your background check: https://trueme.goodhire.com/custom-link/d8586f0f-5775-444f-ac73-ffd1b2f23bcd
The background check will ask for Mama's Milk Wrap's location: Durant, OK 74701
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