Placenta Order | Houston

Name * First Last
Email *
Phone * - ### - ### ####
Secondary Phone - This is a number the courier can call when they arrive for pickup. Someone who has just given birth may be unavailable for answering the phone at this time, so a secondary number is handy. - ### - ### ####
What is the best address for delivery of your transport kit/pills? *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Estimated Due Date * / MM / DD YYYY
Planned Birth Location *
Choose your encapsulation package. All packages include placenta pickup via medical courier, processing, pills and delivery of your products to you. *

Choose your encapsulation package. All packages include placenta pickup via medical courier, processing, pills and delivery of your products to you. Basic - Placenta Pills ($239) Classic - Placenta Pills, Transport Kit, 1 placenta product ($259) Deluxe - Placenta Pills, Transport Kit, 2 placenta products, streamed breastfeeding class ($279)
Choose clear vegetarian capsules or flavored gelatin capsules. The gelatin capsules are opaque and have a very light flavor (which can help with any aftertaste).

Choose clear vegetarian capsules or flavored gelatin capsules. The gelatin capsules are opaque and have a very light flavor (which can help with any aftertaste). Berry Clear Vegetarian
I am choosing the following placenta products. Select one for the Classic Package and two for the Deluxe Package: (Tincture contains alcohol)
Tincture Healing Salve Postpartum Herbal Bath Placenta Print (additional $10)
Encapsulation Method (The default is raw preparation. Please note that regardless of preparation choice, ALL placentas are processed above food safe temperatures.)

Encapsulation Method (The default is raw preparation. Please note that regardless of preparation choice, ALL placentas are processed above food safe temperatures.) Raw (sliced raw, dehydrated at 160 degrees) Traditional Method - TM (steamed, sliced and dehydrated at 160 degrees)
Would you like us to include a cord keepsake? (Cord keepsake is not for consumption.)

Would you like us to include a cord keepsake? (Cord keepsake is not for consumption.) Yes, please include (free) Gold "plated" Cord ($6) No, do not include
Do you want us to include a cord keepsake? (Cord keepsake is not for consumption.)
No, do not include Yes, I want the cord dried natuarlly. (free) Yes, I want a gold cord. (free)
Is there anything else you want us to know?
How'd you hear about us? *
Acknowledgments
We are not a licensed medical professional and does not diagnose, treat, or prescribe for any health condition. No specific benefits are promised and benefits have not been evaluated by the FDA. It is your responsibility to determine if using placenta preparations may be of benefit to you. Placental supplementation is intended solely for ingestion by the individual who has birthed the placenta(s).

It is your responsibility to discuss release of your placenta from your place of birth. Your placenta should not be treated with alcohol, formalin or any other preservative. If it is, it is no longer eligible for encapsulation.

To insure pickup, please call the 833-PLACNTA number rather than our office line. *

We are not a licensed medical professional and does not diagnose, treat, or prescribe for any health condition. No specific benefits are promised and benefits have not been evaluated by the FDA. It is your responsibility to determine if using placenta preparations may be of benefit to you. Placental supplementation is intended solely for ingestion by the individual who has birthed the placenta(s).

It is your responsibility to discuss release of your placenta from your place of birth. Your placenta should not be treated with alcohol, formalin or any other preservative. If it is, it is no longer eligible for encapsulation.

To insure pickup, please call the 833-PLACNTA number rather than our office line. I agree
Please initial the following:
If your or your baby develops an infection at the time of delivery or within the following 24 hours after delivery - it is important to let us know so we can determine the safest options. Initial that you will notify us within 24 hours if an infection is diagnosed. (Please note, a positive GBS status is NOT an infection.) *
I understand that I am responsible for storing the placenta on ice or in other refrigeration, calling for pickup in a timely manner and having someone available to hand the placenta to the courier when he arrives. We cannot refund if the placenta was not on ice/refrigeration for more than 2 hours or if you fail to contact us at 833-PLACNTA concerning pickup. You are responsible for any extra courier fees due to wait time at the pick up location.
When you submit your order, an encapsulator will be put on call so we are ready whenever your baby arrives. You will receive an email with our on call number for pickup and answers to frequently asked questions. Refunds (minus any costs incurred) are only provided when a placenta cannot be safely encapsulated due to infection. Please note, neither a positive GBS status nor meconium is a contraindication for encapsulation, thus is not eligible for a refund. However, we work with all hospitals, pathology labs, birth centers and providers and can assist you as needed.
Draw your signature into the box below to acknowledge the terms of the above contract. *

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Great Expectations Doula Client Code (if applicable)
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+Tax 7%

Placenta Order | Houston

Placenta Order | Houston

Acknowledgments

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+Tax 7%

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