New Recipient Registration

Thank you for choosing Mothers’ Milk Bank Northeast to provide safe pasteurized donor human milk for your precious baby. Our milk meets stringent screening and processing safety guidelines. Your baby’s health is important to us.

When you use this secure site to complete our New Recipient Registration, you set up an account with Mothers’ Milk Bank Northeast. You are not ordering or paying for milk when you fill out these forms. After you register, you can receive milk in one of these three ways:

  • Via our hospital Donor Milk to Go Program (if your baby is a patient at a hospital, ask your lactation consultant if your hospital participates).
  • Visit one of our Outpatient Dispensaries.
  • Place an order directly with Mothers’ Milk Bank Northeast by emailing our Orders Department or calling 617-527-6263 x 4.

To set up your account, you will need names, addresses, phone numbers, and emails of all the parents/guardians/caregivers authorized to pay for and receive milk for your baby. You will need to submit your credit card information at the end of this form. Your credit card will not be charged until your order has been placed.

Please plan to set up the account when you have about 10 minutes of uninterrupted time. If you are interrupted, click on the “Save” button in the bottom right hand corner of the form.

At the end of the form, click “Submit” and your information will be sent securely to our Orders Department. You will receive confirmation immediately, by email, that you have successfully created your account. Please check your junk/spam email folder if you do not receive this confirmation. If you are picking up milk at a hospital or dispensary, you will need your confirmation number.

When registering, please review the following additional information and forms:

If you have any questions, call 617-527-6263 x 4 or email our Orders Department.