Got a breast pump? We carry insurance-covered accessories for all the major breast pump manufacturers. We'll verify with your insurance to see which accessories, such as extra tubing, breast shields and more, are covered at no cost to you.
First Name
Last Name
Email
Phone Number
Your Date of Birth (Numbers only, YYYYMMDD)
Baby's Due Date/Date of Birth (Numbers only, YYYYMMDD)
Did you order your pump through The Lactation Network? Yes No
If yes, has your insurance or doctor information changed since you placed your order? Yes No Not applicable, my insurance is the same as my last Ashland Breast Pumps order
Insurance Provider
Insurance ID
Group Number
Doctor's Name
Doctor's Phone Number
Shipping Street Address
Address Line Two
City
State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip/Postal Code
Breast Pump Model Ameda Mya Elvie Evenflo (all models) Lansinoh (all models) Medela Freestyle Medela MaxFlow Medela Sonata Medela Symphony Motif Luna Spectra (all models)
Breast Shield Size (in mm) 20 21 24 24.5 25 27 28 30 30.5 32 33
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