Please read each section carefully & sign your full name to state you understand & agree.
Placenta encapsulation is the act of taking a fresh, raw placenta, washing the placenta, steaming or slicing the placenta raw, dehydrating, grinding and putting the placenta powder into consumable capsules. All processes are done with respect and education of that placenta and in a sanitary environment. My business is adhering to strict OSHA guidelines and I am following proper food safety standards. The placenta capsules that are being prepared are for your (owner of the placenta) consumption only and are not designed to reverse medical conditions or ailments from pregnancy, to treat postpartum depression, to ensure normal milk supply or to replace medical attention.
I am not a licensed medical professional such as a care provider or physician and I am not able to diagnose, treat or prescribe for any health condition. Services and fees are for the service of encapsulating your placenta, not for the sale of the capsules. Each woman will react to her placenta capsules in different ways. Some of the ascribed benefits of placenta consumption are supported by ongoing research; however these benefits have not been evaluated or approved by the Canadian government or the Food and Drug Administration. It is your responsibility to determine whether using placenta capsules can be beneficial to your wellbeing postpartum.
It is your responsibility to notify me within 8 hours of the birth so that we can work together to make arrangements for pickup or drop off. Failure to do so may result in delayed placenta preparation and encapsulation and may cause decreased potency of nutrients, hormones, and other beneficial attributes of the placenta. Improper storage of the placenta prior to pick up or drop off may result in spoilage. It is your responsibility to discuss release of your placenta from the facility where you will give birth during the prenatal period and to ensure proper storage of your placenta in a refrigerator or cooler. This can be done by placing the placenta on ice until it can be retrieved for preparation and encapsulation.
It is also your responsibility to inform me of any known bloodborne illness (es) or other health issues (such as HIV, hepatitis, etc.) that could place me or any others who may come in contact with your bodily fluids (specifically maternal and fetal blood as well as amniotic fluid) at risk. Some specific sexually transmitted diseases such as Hepatitis or herpes may preclude me from offering placenta encapsulation in my home.
My responsibilities include maintaining client confidentiality, committing to preparing and returning your capsules within 72 hours of receiving your placenta (usually within 36-48hours), and upholding the highest standards of cleanliness, safety, and quality of professional placenta preparation services. In the event that I am unable to be available for your placenta encapsulation, I will provide a backup placenta specialist who is capable of providing services or I will instruct you on how to preserve your placenta until I am able to pick up and complete encapsulation.
It is important to understand that there may be circumstances in which your placenta cannot be used. Significant abnormalities of the placenta may necessitate your doctor or midwife sending your placenta to Pathology for further examination. Once the placenta has been released to Pathology, I will not be able to encapsulate. Other conditions, such as signs of infection in the mother during labor, may mean that consuming your placenta could be harmful to your health. I will always consult with you prior to making a choice on whether or not your placenta is viable for ingestion. It should be possible to claim your placenta after caesarean surgery. It is important that you let me know if you have any health concerns or conditions which may affect the health of your placenta or the health and safety of anyone who may come into contact with your placenta.
I do not hold Gemma Remple responsible or liable for any transport mishap that is beyond her control (ex. car accident or detainment).
Photography & Videography Release
I agree to release any and all photographs and videotaping of the placenta to Gemma Remple for marketing, social media, educational or instructional purposes. I understand that all personal information including name, date of birth, address or child’s name will remain confidential. There will be no distinguishing information about the placenta shared. I also understand that Gemma Remple will watermark all pictures or videography of the placenta to ensure safe usage
Payment & Refunds
In the event your placenta is unavailable to you (ex. sent to Pathology and not released) or if your placenta has been contaminated with a bacterial infection, you will be entitled to a refund sans the amount of the $50.00 non-refundable deposit. There will be no refund and payment will be due in full once preparation has begun, even if you choose not to take delivery of the finished capsules
I understand that there is a $50 non-refundable deposit to book the service & the remainder of the processing fee is due upon receipt of your prepared placenta pills. Spaces are limited and booked on a first come, first serve basis.
I understand that a transport/shipping fee may be required if I live outside of the Kimberley/Cranbrook area.
I have read, understood, and agreed to the above information. I accept the responsibility of gaining possession of my placenta, and notifying my placenta specialist within 8 hours of my birth. I understand the importance of appropriate handling and storage of the placenta. By signing below I authorize the release of my healthy placenta to Gemma Remple for the purposes of placenta encapsulation and keepsake preparation for my own personal use.
Please etransfer the deposit to gemmaremple@gmail.com upon completion of this form.