Breastfeeding Support Chat - Enrollment Form

Thank you for your interest in our breastfeeding chat support program. We are here to provide guidance, answer questions, and offer encouragement on your breastfeeding journey. Please fill out the form below to enroll.

* Indicates a required question.

Your Name*

First Last

Mobile Number*

City*

County*

Preferred Language:*

English
Spanish
Creole
Other

You chose "Other", please specify:*

Race/Ethnicity:*

American Indian/Alaskan Native
Asian
Black/African American
Caucasian/White
Hispanic/Latino
Native Hawaiian/Pacific Islander
Southeast Asian
Choose not to answer

Are you breastfeeding?*

Yes
No
No, but I am interested

How can we support you in your breastfeeding journey?*

Select the topics that interest you.

You chose "Other", please specify:*

Terms and Conditions*

I agree to receive 2-3 SMS messages per week from The Cooperative (the parent company to Family Health Initiatives (FHI)). Message and data rates may apply. I can reply STOP at any time to opt out of the program.
I have read and agree to the Terms & Conditions for this.

This text program is not meant to replace regular medical care provided by your doctor, but to enhance the care plan provided by your doctor. Be sure to visit your doctor regularly.

FHI Breastfeeding Support Chat

Enrollment Form