six bottles of breast milk with a storage sack that are for purchase

Outpatient Donor Milk (600 mls)

Payment for SIX 100 ml bottles of outpatient donor milk.

Parent Agreement for purchase of donor human milk:

Parent understands purchase is limited to SIX (6) bottles per infant as indicated on prescription.

This is a one-time order to help you transition from hospital to home. Additional milk for longer-term use must be obtained from Northwest Mothers Milk Bank directly as stock is limited at the distribution site. Please call us at 503-469-0955.

Once milk is purchased, milk cannot be returned. If milk purchase exceeds order limit, Northwest Mothers Milk Bank will refund any overpayment.

$100.00

Infant's Full Name and Mother/Parent's Name on Prescription

Initial to confirm you have read the Parent Agreement

Quantity