Recipient Intake

By completing the forms online, they will automatically be submitted to us.

For forms that are downloaded, you may submit these to The Milk Bank via fax at 317-536-1676, email

For any questions, please call The Milk Bank directly

Dear Families,

We believe in the power of breastmilk and pasteurized donor human milk (PDHM) to address critical infant and public health outcomes.  The use of donor milk may be necessary for a wide variety of medical conditions or for short-term supplementation.  This packet provides information on how you can access donor milk.

PDHM is available both as inpatient care and outside of the hospital setting.  However, if supply becomes limited, The Milk Bank follows national triage standards based on medical needs.

If you need milk for short-term use, you may purchase up to 40 ounces without a prescription.  For infants that require more than 40 ounces, a physician’s prescription is required and should include the diagnosis, and the approximate amount of PDHM needed on a daily/weekly basis. Prescriptions are subject to renewal based on infant age and medical needs.

To receive milk, outpatient families must:

  • Complete the Recipient Intake. The forms can be completed online or downloaded and returned to The Milk Bank via fax (317-536-1676), email  (, or mailed to our address above.
  • Provide Physician’s Prescription if need exceeds 40 ounces.
  • Provide payment of processing fee of $4.85 per ounce via secure online credit card, cash or check.  This amount helps to offset the costs to collect, pasteurize, test, bottle, store, and ship each ounce of PDHM.  While The Milk Bank does not directly bill insurance companies, your insurance provider may reimburse you for PDHM on a case-by-case basis. TMB can provide supporting documentation to help you seek reimbursement.  The Milk Bank does offer a Medical Relief Fund including a sliding fee scale.
  • Indicate how you would like to receive milk. For short-term use and under 40 ounces, we recommend you pick up from The Milk Bank or one of our conveniently located Donor Milk Express sites.  If you are not located near a milk express site, you can also request a direct-ship options (shipping/handling rates apply).  To allow time for processing shipped orders, we request that orders are received by 2:30pm Monday -Thursday and by 12pm on Fridays. Please note, that any out of hours inquires will be handled the next business day.

Again, thank you for your interest in our outpatient program. We know you want the best for your child – and so do we – so please do not hesitate to contact us with any questions!  We look forward to partnering with you to support your medical and family needs.

Sarah Long, IBCLC
Director of Clinical Operations
The Milk Bank

Additional documents you should be aware of are available below, please take a moment to review them and retain them for later referral: