Refer a Patient

We welcome referrals from a variety of providers, including lactation consultants (IBCLCs), feeding therapists (SLPs, OTs, etc), bodyworkers (DCs, LMBTs, PTs, etc), primary care providers, OBGYNs, midwives, mental health counselors and therapists, Psychiatrists, and more.

To send in a referral, simply fill out this form and we will reach out to the patient directly. Please also feel free to contact us with questions about referrals through this site, by emailing sara@wonderfullymadenc.com, or by calling/texting 919.480.1935. We’re here to collaborate and evolve, always.

NOTE: This is for peer-to-peer references only. If you are a parent, please reach out to us via our Contact page.

Referring Provider Name

First Name

Last Name

Referring Provider Credential

Practice Name

Provider Email Address

Provider Phone Number

(###)

###

####

Patient Name

Patient Date of Birth

YYYY

Patient Email Address

Patient Phone Number

(###)

###

####

What services are you referring for?

Lactation Consult

Therapeutic Breast Ultrasound

Menopause Consult

Other

Anything Else You'd Like us to Know?

Visit Us

251 W Center Street
Holly Springs, NC 27540
(Located inside Village Physical Therapy)

Phone
(919)480-1935

Fax
(919)577-9292

Email
sara@wonderfullymadenc.com

Refer a Patient

Visit Us

You belong here. ♡