Getting Started…

Please complete our online form to begin your breast pump order process.

We are here to help you process your request for your new personal use breast pump! The information we collect on this form is required for insurance benefit confirmation and the processing of your breast pump order.

In preparation of your baby’s arrival, we confirm your insurance breast pump benefit ahead of time. We then contact you to assist you with your breast pump selection and confirm your insurance covered breast pump.

In addition to completing this form, a prescription for an electric breast pump must be issued by your healthcare provider. The prescription can be faxed or emailed to Milk N Mamas Baby. Our Fax number is 888-606-8425. Once we receive your completed order and prescription, we promptly route your breast pump for delivery! Our order process is seamless. Remember we are here to help, you may call us for complete assistance with your order process 844-MILK-MOM.

Insurance Signup

Mom's Information


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Baby's Information


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Doctor's Information


Doctor's Name(Required)
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Max. file size: 256 MB.
If you have a prescription, you can upload it here. Otherwise, we can fax a request to your Doctor.

Insurance Company Information


Tricare members please use DOD Benefits Number (DBN) or Sponsors Social
This should be the Member's Services phone number.

Select Your Breast Pump

Select from the breast pumps below and we'll begin the confirmation and shipping process.


Motif


Motif
Less than half a pound, the quiet Duo fits in one hand and discreetly slips into any bag.
Motif
For busy moms Motif offers a rechargeable battery-powered version of the Luna with a battery life of 2+ hours between charges.
Motif
Sophisticated, strong, and soothing. The Luna is the powerful breast pump from Motif Medical, built for modern motherhood.

Medela


Medela
The Pump In Style Advanced Breastpump Starter Set is part of Medela’s patented 2-Phase Expression technology pump family.
Medela
The compact design and USB-chargeable battery give you flexibility with no compromise on pumping performance.

Spectra


Spectra
For moms wanting complete portability and flexibility so they can pump how they like, when they like and where they like.
Spectra
Boasting every innovation possible to make life easier for you, including powerful 300mmHg suction, double pumping, and much more.
Spectra
This pump is absolutely quiet and is the most portable and stylish hospital grade pump around.

Other Premium Brands


Other Premium Brands
With Elvie Pump you can lead the conference call, play with your kids, or enjoy some peace and quiet… all while you pump
Other Premium Brands
Designed to be compact with features the world’s only FDA-cleared pump kit that helps protect breast milk from contaminants.
Other Premium Brands
Take Back Your Freedom with the BabyBuddha Complete Kit. Designed to free your hands and enhance your productivity.
Other Premium Brands
Sleek wearable Elvie Stride, ideal for on-the-go Mamas.