Insurance Order Request Form

Thank you for choosing UC Milk Bank

This form is only for families with an approved medical necessity for UC Milk Bank donor milk and an active Letter of Agreement (LOA) with your insurance provider.

Please Note:

All order requests are subject to review and approval. If approved, you will receive a confirmation email. A team member will contact you if additional information or documentation is needed to process your request.

Parent/Guardian

Updated Letter of Medical Necessity, if requested by medical team

Browse

Insurance Coverage

Please notify UC Milk Bank in the case of recent changes to your Insurance Coverage.

Insurance Provider

Donor Milk Request

Orders placed Monday through Thursday by 11AM are shipped same day via FedEx Priority Overnight Delivery.
*No weekend deliveries available. Orders placed after Thursday 11AM will be shipped Monday for delivery Tuesday.

Order Request

ORDER LIMITS: Local Pickup 6 to 30 bottles, Shipping 30 bottles

Shipping Address

Street, City, State, Zip Code

I acknowledge that donor human milk is a limited resource. Submission of an order request does not guarantee fulfillment, quantity requested, or delivery date. All requests are subject to available inventory, medical prioritization guidelines, and operational considerations at the time of processing.