Intake Form
To book your placenta encapsulation, please fill out the client intake form and pay the $50 deposit.
1). Complete the Client Intake Form
Client Information/Instructions
I recommend printing a copy of the Information/Instructions, and either placing in a visible location in your home (home birth) and/or packing in your hospital bag so that you're able to refer to it when you deliver.
Waiver of Liability/Services Agreement
Please print, initial, and sign the Waiver/Services Agreement. I will collect it from you when I pick up your placenta, or you may scan a signed copy and email it to me.
Hospital Printout (Optional)
Print and pack this in your hospital bag. Hang in your room as a reminder to the hospital staff that you wish to keep your placenta.
2). Pay the booking deposit or pay in full
Placenta Encapsulation Services - TCM Inspired Method
Booking Deposit: $50
Please note the booking deposit is non-refundable.
The remainder of the balance for services rendered is due at the time I pick up your placenta to begin preparation, and can be paid via PayPal, Venmo, debit/credit card, or by cash.
If you wish to take care of this in advance, you may pay in full now.
3). Download & print the Client Information/Instructions & Waiver of Liability/Services Agreement