Client Booking & Payment Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState

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Email

example@example.com

Phone Number

Area CodePhone Number

Estimated Due Date

Date

Partner/Contact Person

First NameLast Name

Partner/Contact Person's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Location of Birth

Have you had any of the following during pregnancy? Please check all that apply even if you have received treatment. If you have a history of the following, check the "other" box and add to the notes at the bottom of form

List Any Allergies

Acknowledgment of Non-Refundable Booking Fee

Complementary Cord Keepsake With Every Service

Please let me know if you were referred by someone so that I may thank them!

Any other notes

My Products

Non-Refundable Booking Fee

I am aware that there is a $50 Non-Refundable Booking Fee that will be deducted from the Package Price. Balance of Package will be required by 36 weeks at which time I will be issued with a Blissful Postnatal Gifts Esky and Placenta Handling & Transport Guide. Esky remains the property of Blissful Postnatal Gifts at all times.

$50.00 AUD

Basic Package: Placenta Encapsulation - Non-Refundable Booking Fee included

Complimentary Cord Keepsake

$349.00 AUD Quantity

Blissful Package: Placenta Encapsulation & Placenta Tincture x 100ml bottle - Non-Refundable Booking Fee included

Complimentary Placenta Print & Cord Keepsake

$399.00 AUD

Goddess Package: Placenta Encapsulation, Placenta Tincture x 2 100ml bottles & Placenta Salve - Non-Refundable Booking Fee included

Complimentary Placenta Print & Cord Keepsake

$499.00 AUD

Twin Placenta Fee

Please add if you are pregnant with twins

$50.00 AUD

Placenta Print

Placenta prints are similar to watercolour prints. They are beautiful keepsakes of “The Tree of Life” that sustained your baby during pregnancy.

$25.00 AUD

Placenta Tincture

Using part of your placenta in Tincture form is another way to stretch out its longevity

$60.00 AUD

Placenta Salve

Infused with the magic of your dehydrated placenta, this beautiful, dehydrated placenta salve makes a perfect first aid cream for cuts and scrapes but also aids in healing from caesarean wounds, cracked nipples, nappy rash, sunburn, and almost any other skin wound. Contains: Your Dehydrated Placenta Powder, Coconut Oil, Sweet Almond Oil, Shea Butter, Beeswax, Calendula, Plantain, Pau‘d Arco, Lavender, Frankincense, Myrrh, carrot seed essential oils

$50.00 AUD

Blissful Basic Salve

Perfect for soothing nappy rash, sunburn, and almost any skin wound Contains: Coconut Oil, Sweet Almond Oil, Shea Butter, Beeswax, Calendula, Plantain, Pau‘d Arco, Lavender, Frankincense, Myrrh, carrot seed essential oils

$24.95 AUD

Express Postage

If you live >30km from Bundaberg CBD and have arranged drop off for your placenta, I am happy to Express Post your Encapsulated Placenta Package directly to you for a fee

$21.90 AUD

Cord Keepsake Box

A beautiful case to hold your baby's umbilical cord - preserving a small portion of this once in a lifetime connection in a meaningful way

$10.00 AUD Quantity

Total

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Blissful Postnatal Gifts Client Booking & Payment Form

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Client Legal Agreement

My Products

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