Agreement Type *

($300) Placenta Encapsulation clients only: I will pickup your placenta as soon as possible after birth, process it in my home in two consecutive days and have the product ready within 24-48 hours.

($275) For current doula clients: I will leave your birthplace with your placenta, process it in my home and have it ready in 24-48 hours.

Services

Placenta Encapsulation (Traditional Chinese Method) *most popular

Placenta Encapsulation (Raw method)

2oz Organic Healing Salve (additional $30)

4oz Tincture, alcohol based (additional $30)

Placenta Print (Free)

Cord Keepsake (Free)

Framing of placenta print (additional $50)

Name *

First Name

Last Name

Phone

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Estimated Due Date

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DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Partner's Name

First Name

Last Name

Partner's Phone

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Client *

As the client, I understand that it's my responsibility to arrange for someone to contact Taylor right after the birth of my baby so that she can come pick up the placenta.

As the client, I understand that it's my responsibility to discuss the release of my placenta with my physician/midwife before giving birth.

As the client, I understand that I'm responsible of the safe handling of the placenta after birth. It's my responsibility to ensure proper storage of my placenta in a refrigerator or a cooler with the placenta placed on ice until it can be picked up by Taylor. Failure to do so, may result in the placenta losing important nutrients or even spoilage, which would render it unusable for encapsulation.

By checking this, I understand that I am allowing Taylor to pick up my placenta from my birthplace in order to encapsulate it.

By checking this, I understand that no guarantee of results is either offered or implied. I understand that my encapsulator, Taylor, (or their training organization) are not medical professionals and do not diagnose or treat illness.

I understand that general guidelines for dosages are provided for reference only and I trust in my own ability to follow my body for actual dosage decisions.

I release Taylor and their training organization from all liability resulting from consuming my placenta.

By checking this, you are confirming that you do not have any blood-borne related illness or health issues that are transmitted through bodily fluids.

By checking this, I understand that if I happen to develop an infection during labor, my placenta will no longer be viable for encapsulation and I have the responsibility to notify Taylor.

I require proof that you do not have any of the following transmissable diseases: HIV, Hepatitis B and C, Syphilis. By checking this you understand that you will need to send me lab records from your physician. *

I agree

Photo Release

By checking this, I am allowing Taylor to share photos of my placenta on their website and social media pages.