for Ibolya Rózsa, IBCLC
For appointment call:
+36 30 583-4877
Please, do not submit this form before setting up an appointment.
By submitting this form you accept the Home Visit Consultation Terms and Conditions.
Just a reminder: when is our appointment?
Home address (where to visit)
Baby's full name (use dash to separate if twins)
Baby's date of birth
Does the baby suffer from any illnesses?
Weight at birth
Length at birth
Lowest weight? When?
Number of siblings
How successful your previous breastfeedings were, if any?
Please, describe your recent breastfeeding problem.
Have you already consulted anyone else about this particular problem?
Please, share the advice you received.
Pediatrician's contact details
Health visitor's (védőnő) contact details
Do you have any problem with your thyroid (pajzsmirigy) function?
Do you have or have you ever had Policystic Ovarium Syndrome - PCOS?
(Tap button for positive answer)
Do you have diabetes?
Any other known illnesses?
Did your breast grow during pregnancy?
Have you had breast surgery?
Do you take oral contraceptives (pills)?
Do you have a history of depression?
Do you smoke?
Do you regularly take any medications or vitamins?
Do you use herbs?
We are halfway through...
Any complications during your pregnancy?
The hospital you delivered at
Method of delivery?
During labour and delivery, did you get?
Did you breastfeed your baby in the delivery room?
If not, when did you breastfeed first?
How often did you breastfeed?
Did you room-in with your baby in the hospital?
Were you together during nighttime?
Did you breastfeed during the night?
Did your baby receive water, tea or formula during your hospital stay?
Did you use bottle, pacifier (dummy) or nipple shield in the hospital?
Was your baby jaundiced (yellowish skin due to hyperbillirubinaemia)?
If yes, what treatment did your baby receive?
How long after birth did you go home and what was the baby's weight at that time?
When did the problems start at home?
How often does your baby nurse?
Do you measure your baby's weight before and after nursings?
Do you exclusively breastfeed or your baby gets...
Do you give your baby pacifier (dummy), bottle or use nipple shield?
Do you pump?
Number of wet diapers?
Color of urine?
Number of stools?
Color of stools?
Any injuries on your nipple?
Is breastfeeding painful?
A few more questions...
What solution do you expect from me?
How did you learn about me?
See you soon.