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Breast Milk Donation Form

Thank you for your interest in donating breastmilk. By completing this form, you will be initiating the process to donate breastmilk to the WakeMed Mothers’ Milk Bank. Our screening process includes submission of this form, completion of an interview, submission of a signed consent form from your healthcare provider and a blood test provided at no cost to you. Following approval, your generous breastmilk donation will directly benefit babies in NICUs on the east coast.

Please expect to hear from us within two days of form submission. If you have any questions or concerns, please feel free to contact us directly by calling 919-350-8599 or emailing us at

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