Q: How do we make sure our patients know they have a choice when it comes to getting a breast pump?

A: Patient choice is an important consideration. Our suggested protocol for ensuring patients know they have a choice is to communicate this clearly when introducing the Breast Pump Depot® program to them. Appropriate patient choice protocol language for a hospital to adopt is as follows:

"You can choose where you get your breast pump, but we have a program that helps moms that qualify get breast pumps very quickly and easily at no out-of-pocket cost. Would that help you?"

Some facilities have patients sign a form documenting their choice to use Breast Pump Depot®. Upon request, we are happy to provide an example of this form which includes the following language:


(To be printed on Facility’s letterhead) 

Dear Patient: 

To promote breastfeeding among new mothers, ("Facility") has entered into an arrangement with The Breast Pump Depot ("Breast Pump Depot") to provide breast pumps for our patients. The Breast Pump Depot is an on-site service that can provide you with a breast pump when you are preparing to discharge from the hospital. 

You have the right to receive this item from any supplier, though not all health insurance plans contract with all suppliers. You may elect to receive the item from Breast Pump Depot, or another supplier of your choice. Please be advised that Facility has a contractual arrangement with Breast Pump Depot, but neither Breast Pump Depot nor Facility receive any compensation through the arrangement. If you do not wish to use Breast Pump Depot as your supplier for your breast pump, please let Facility staff know. 

By signing this notice below, you are indicating that that you understand the relationship between Facility and Breast Pump Depot, you have had the opportunity to select a supplier, and you have chosen Breast Pump Depot as your breast pump supplier. 

If you have any questions, please let us know and we will be happy to discuss them with you. 



[Patient Coordinator Staff] 


Patient Signature ___________________________ 

Patient Printed Name _________________________ 

Date  ___________________ 


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