The following items are blank or not valid and must be updated:
First Name
*
Last Name
*
Phone
*
e.g. 555-555-5555
Email
*
Was your baby born premature (less than 37 weeks)?
*
Yes
No
Was your baby given cow-based formula or fortifier (Similac or Enfamil)?
*
Yes
No
Did your child suffer from intestinal issues after consuming Enfamil or Similac formula?
*
Yes
No
Where was your baby born (city/state)?
What year was your baby born?
When would be a good time to call you?
--Select--
8am-10am
10am-12pm
12pm-2pm
2pm-4pm
4pm-6pm
Anytime
Central Time