Thank you for booking Encapsulation. Please take your time to read and fill out this form. 

This is the official agreement for Placenta Encapsulation Services between The Preemie Doula, LLC Alternative & Holistic Reproductive Services and, CLIENT (S): After this contract is signed you will get a invoice sent to your email where 50% deposit is required for booking or you may send it to 253-249-5781

It is Very Important that the person in the room with you or your support person is aware of your wishes and will make sure your wishes are met regadless of your condition. The person that will be in the room with you and able to assist us with  making sure it doesnt leave the room until we arrive and help with the pickup process.

Below you will find your options for your placenta encapsulation, placenta print and umbibical cord keepsake. Please leave the section blank if you would not wish to make it an add on to your package. Which means you will have regular capsules for no extra charge.

All flavored capsules are Kosher & Halal certified. All colored capsules are Vegetarian.You may select plain, flavored, or colored capsules as an option for your placenta pills. All items are add ons (except plain).

Colored: $20                                           Flavored:$15

Please only select a FLAVOR OR COLOR. (Please do NOT select both)

Placenta prints are a safe and beautiful way to always remeber your placenta. Because of the structure of the placenta, you will have to pick 2-3 colors so that you get a good vision of your placenta. Rainbow is also available !!!

Please note that if you select a placenta print but no color, the placenta blood bill be used for the print. You may also select Blood Print.When using placenta blood, the placenta may not always come out as visually clear that you would like, though you will still be able to see it.

10 additional for each add on (cannot exceed 3)

Please allow 72-96 hours for regular placenta encapsulation services and up to 96 hours if you select additional services.

• After agreement is signed and fees are paid you are officially a client of The preemie doula
• Please send text message to 252-249-5781 when you go into labor 
• Send another text (room number) when the baby is born
  
• DECLINE ALL TESTING, WE WILL BE THE JUDGE OF THAT
• Do not let your placenta leave the room
• The support person has the last say so
• Hospital will package placenta and can provide ice. You have the cooler.

• Hospital will have you sign a “Organ Release” form
• I will be there within 2-3 hours after the birth to pick up placenta.

• Non Hospital Process
• Bring small cooler to place placenta in (Optional); cooler will be provided by pick up personanelle.

• Send another text when the placenta has arrived
• Package placenta in a gallon sized ziploc bag and a cooler (optional)
•  Place in fridge till arrival; placenta is safe at room temperature up tp 4 hours of delivery

• After agreement is signed and fees are paid you are officially a client
• Please send text message to 804-637-8398 when you go into labor 

• Send another text (room number) when the baby is born
• Hospital will package placenta and can provide ice
• Hospital will have you sign a “Organ Release” form
• A Team Member will be there within 2 hours after the birth to pick up placenta.Non Hospital Process
• Bring small cooler to place placenta in (Optional); cooler will be provided by pick up personanelle.

• Send another text when the placenta has arrived
• Package placenta in a gallon sized ziploc bag and a cooler (optional)
•  Place in fridge till arrival; placenta is safe at room temperature up tp 4 hours of delivery