• Sacred Seasons Birth- Arkansas' Premier Placenta Encapsulation Company

    Local Client Order Form & Contract

    Thank you for choosing Sacred Seasons Birth! Please complete the order form and service contract below and submit your $75 deposit. Please don’t hesitate to reach out with questions or concerns. I look forward to serving you & your family!
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  • Permission to Post a Birth Announcement 

    Having a baby is so exciting! If we are given permission, we like to make a "welcome baby" post on our social media accounts. We do not include any identifying information, just the sex of the baby and the city in which they were born. 

  • Categories:All
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    Placenta Capsules
    Keepsakes
    Salves
    Tinctures
    Final Product Delivery & Outside of Service Area Pick-Up Options
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              Placenta Capsules
              Preparation Method Product Image
              Preparation MethodTCM- placenta is gently steamed in a double boiler, with organic herbs & spices added to the water. This shrinks the placenta slightly and will affect the yield by 10-15 capsules. Simple Prep- no additional steam is added to the placenta before the dehydration process. Yields the most capsules. 1/2 & 1/2- half TCM and half Simple Prep. A fantastic option for receiving the different benefits of both prep methods.
              $285.00

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              Keepsakes
              Umbilical Cord Keepsake  Product Image
              Umbilical Cord Keepsake Automatically included with each order. IF you DO NOT want a cord keepsake, it will be blended in with the rest of your placenta powder, so please be sure to make your selection carefully. Be sure to answer all of the questions in the three drop-down boxes below
              $ Free

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              Placenta Prints  Product Image
              Placenta Prints Placenta prints are made by gently pressing high-quality watercolor paper onto the baby's side of the placenta. The paper absorbs the residual fluids and reveals a "stamp" of the placenta. Each order includes 2 prints. The first set is $35. Additional sets (2 per order) are $10 each.
              $35.00

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              Salves
              4oz Nourishing Salve Product Image
              4oz Nourishing SalveSAFE FOR BABY. I DO NOT add essential oils, preservatives, or dehydrated placenta to the mixture, making this option 100% safe for baby. Use on cracked/sore nipples, baby acne, diaper rash, circumcision wounds, and many other minor cuts/skin irritations. The first salve is $65. Additional salves are $25 each.
              $65.00

              Item subtotal:$0.00
                
              2oz Nourishing Salve Product Image
              2oz Nourishing SalveSAFE FOR BABY. I DO NOT add essential oils, preservatives, or dehydrated placenta to the mixture, making this option 100% safe for baby. Use on cracked/sore nipples, baby acne, diaper rash, circumcision wounds, and many other minor cuts/skin irritations. The first salve is $65. Additional salves are $25 each.
              $45.00

              Item subtotal:$0.00
                
              4oz Placenta Salve Product Image
              4oz Placenta SalveDO NOT USE ON BABY. Made with infusing the butters and oils with the stem cells from a small portion of your placenta powder, creating a powerful healing balm to be used on c- section and episiotomy scars. The concentration of hormone in the salve may cause swollen nipples and/or genitals on baby. The first salve is $65.00. Additional salves are $25.00 each.
              $65.00

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              2oz Placenta Salve Product Image
              2oz Placenta SalveDO NOT USE ON BABY. Made with infusing the butters and oils with the stem cells from a small portion of your placenta powder, creating a powerful healing balm to be used on c- section and episiotomy scars. The concentration of hormone in the salve may cause swollen nipples and/or genitals on baby. The first salve is $65.00. Additional salves are $25.00 each.
              $45.00

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              Tinctures
              4oz Placenta Tincture  Product Image
              4oz Placenta Tincture A highly concentrated version of your placenta capsules that takes at least 6 weeks to cure. Tinctures are NOT a replacement for capsules due to the cure time. The first tincture is $45. Additional tinctures are $20 each.
              $45.00

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              2oz Placenta Tincture  Product Image
              2oz Placenta Tincture A highly concentrated version of your placenta capsules that takes at least 6 weeks to cure. Tinctures are NOT a replacement for capsules due to the cure time. The first tincture is $45. Additional tinctures are $20 each.
              $25.00

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              Final Product Delivery & Outside of Service Area Pick-Up Options
              Final Product Delivery Method Product Image
              Final Product Delivery MethodYour products will be securely packaged and shipped to you, via a USPS or FedEx insured package. Shipping of your products is included in the cost of encapsulation. For clients living within Mountain View, Arkansas proper you can have your products hand-delivered for free. Other hand delivery options are listed below. Please be mindful of the distance of your location from Mountain View and make the correct selection.
              $ Free

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              Placenta Pick-Up Outside of Service Area Product Image
              Placenta Pick-Up Outside of Service AreaTo be considered a "local client" and not be required to ship your placenta to me, you must deliver within a two hour drive from Mountain View, AR. In some situations, I am able to drive outside of my service area to pick up the placenta. This is something that must be prearranged prior to the submission of this order form.
              $ Free

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            • Below is important information regarding preparing for placenta collection, payments, refunds, and contract requirements. PLEASE READ before completing and submitting your form. If you have questions, concerns, or need clarification contact Kelli Stone at 940-230-6690 before submitting your order form. 
               

              Preparation and Order of Operation

              The following is a list of items you should take to the hospital, and arrangements to make ahead of time so that everything goes as smoothly as possible on the big day.

              • 3 one-gallon-sized ziplock bags
              • a small styrofoam or otherwise disposable cooler (for sanitation reasons, we cannot return a hard-sided cooler once it has been used to secure and transport your placenta)
              • a copy of your birth plan
              • designate a support person responsible for ensuring the placenta is secured and protected   

              You will receive a welcome text message in a thread that includes you, your support person, Kelli Stone, and whomever else you indicate on the order form. This chat thread should be utilized to keep SSB/Kelli informed on your labor and delivery status. We strongly encourage your support person to be included in this chat thread to ensure all pertinent parties can communicate effectively and efficiently on the day you give birth.

              Be sure to notify Kelli via a text in the designated group chat, 24/7

              • if your water breaks
              • you are in active labor
              • have been admitted to the birthing facility
              • once you begin to push or just before being taken back for a C-section

              Once you've delivered and the placenta is secured, you or your support person needs to approve the final payment request, CALL (not text in the group thread) Kelli to give notice the placenta is ready for transport and maintain possession of the placenta until we arrive for the placenta. 

              *Secured means the placenta has been placed in a leakproof container, with a lid, or has been triple bagged in plastic bags, buried with 2 inches of ice under the placenta and 2 inches of ice on top of it, inside a DISPOSABLE cooler and safely in the possession of the client, her support person, or otherwise designated representative.

              If you are birthing at home, there is no pressure to contact us immediately following delivery. You have up to 72 hours postpartum to call and notify us that you've delivered and are ready for transport.

              Order Form and Contract

              We require the following for you to be added to the service schedule and for us to guarantee services at the time of your delivery

              • A completed order form and contract
              • Remittance of the $75 non-refundable deposit or the full amount of your order, whichever you prefer.

              For us to dispatch to take possession of your placenta, the remaining balance request must be approved and remitted in full (unless you've arranged to pay the remaining balance in cash ahead of time).

              Same-Day Clients

              It is always best to secure services as early in your pregnancy as possible, however, we understand life happens, so we do accept clients currently in labor or have recently delivered, so long as the following conditions are met.

              • The placenta was properly secured within 4 hours postpartum.
              • The placenta can be kept on ice (replenished every 8-12 hours, as needed) or refrigerated for up to 72 hours. After 72 hours, the placenta must be frozen.
              • We highly recommend removing the placenta from the leakproof container and triple-bagging it before freezing it.
              • The placenta can be frozen for up to one year before it is no longer viable.

              It is a requirement for same day clients to pay their entire balance all at once. The deposit is only applicable to clients who are secure services prior to their delivery date. We cannot dispatch out to your location to take posession of your placenta until the entire balance due is remitted.

              Deposit and Itemized Invoice

              The deposit is only applicable to clients who are securing services ahead of their delivery date. A $75 non-refundable deposit is due when you submit your completed order form and contract. The $75 goes toward your overall balance and guarantees service on the day you deliver. As soon as we receive your order form, contract, and deposit, we will generate an itemized invoice reflecting the items ordered, the price of each, and your total balance due. The invoice will not reflect the paid deposit, but any remaining balance will be stated in the welcome message you will receive as soon as we have the order form, contract, and $75 deposit. 

              Payment Options

              We only require the $75 non-refundable deposit to be paid when you submit your order form and contract. However, you are welcome to pay the entire balance, in full, when you submit your order form and contract if that is better for you.   

              Any remaining unpaid balance must be paid, in full, once you deliver. We cannot dispatch to your location to transport the placenta until your balance is fully paid. Failure to remit the final balance in the specified timeframe delays the processing and return of your placenta product(s). 

              If you are a same-day client, it is required to pay the entiire balance in full at the time you submit your order form.

              Payment plans are available upon request, for the duration of your pregnancy, and can be broken up into 2, 3, or 4 installments. Any remaining balance is due at the time of delivery.

              The following are the only forms of payment accepted for remittance of the deposit. The remaining balance may be paid in cash if that arrangement is made before delivery.

              Zelle: Kelli Stone 940-230-6690


              Apple Pay: 940-230-6690


              CashApp: $placentacapsules

              We are a small company and do not have a credit card processing machine. To utilize a credit card to pay your balance we have to use Stripe.

              • You must pay your entire balance when you submit your order form and contract. Stripe withholds funds collected from credit cards for up to 21 days before releasing them to us. 
              • A $10 credit card processing fee will be added to your total balance to cover the fees Stripe charges us. 

              We cannot accept HSA cards.

              Refunds

              Refunds apply ONLY to clients who paid, in full and are determined, at the sole discretion of Kelli Stone, on a case-by-case basis. Refunds are given in the total amount paid, minus the one-time, non-refundable $75 deposit. No refund will be issued after we take possession of the placenta.

              In the case of a birthing facility error or refusal to release the placenta, for any reason, you are obligated to pursue the birth facility for a full/partial refund for the loss of encapsulation services. We cannot guarantee reimbursement will be given by the birth facility.

              You are required to

              • Notify the charge nurse on duty as soon as possible of the situation
              • Contact the birth facility's patient advocate and/or ombudsman to initiate the reimbursement from the birth facility.
              • Document everything as it happens, preferably via recordings.
              • Gather and submit all requested/required documentation as expressed by the birthing facility, to the appropriate parties, within the designated timeline, to resolve the issue properly. 

              Unforeseen Circumstances

              Should extenuating circumstances, such as but not limited to, a car accident, death in the family, extreme illness, or injury, prevent us from collecting your placenta, promptly, at the time of delivery, we will do everything possible to accommodate you properly. Efforts on behalf of SSB/Kelli, such as, but not limited to include:

              • Arranging for a trusted individual to pick up your placenta, within 72 hours of delivery, and deposit the placenta into the storage fridge at the SSB workspace. Kelli Stone will process the placenta as agreed and ship the final product(s), via a USPS-insured package, within 72 hours of processing.
              • Arranging for an alternate encapsulation specialist to take over the entire encapsulation process. This includes picking up, processing the placenta, and returning the final product to you. You may be required to sign a different contract with the alternate encapsulator.
              • If you've paid in full upfront, Kelli will forward that payment to the alternate provider and refund you for any product(s) the alternate provider cannot provide.
              • If acceptable accommodations cannot be arranged or agreed upon within 72 hours of delivery and you decide to not have your placenta encapsulated, Kelli will provide a refund, in full, minus a $75, non-refundable deposit. 
              • In the case of hospital/birthing facility error, or physician refusal to release the placenta for any reason, it is the responsibility of the client to pursue the hospital/birthing facility for a full/partial refund of any fees paid by the client for encapsulation services. It is the client's responsibility to contact the hospital/birthing facility-employed patient advocate and/or the ombudsman to initiate the pursuit of reimbursement from said facility. It is the responsibility of the client to gather and submit all requested/required documentation, to the appropriate parties, within the designated timeline, to resolve the issue properly. SSB/Kelli Stone will provide the client with any supporting documentation possible to expedite the process of obtaining a refund from the hospital/birthing facility. SSB/Kelli Stone is available to speak with any hospital/birthing facility representative and the client, via conference call, to ensure proper client reimbursement from the facility. 

               

              Delivery of Products

              Your final product(s) are shipped, via a USPS-insured package, to the address you designate on the order form, unless otherwise specified.

              • Your products will be shipped to you within 72 hours of us receiving the placenta.
              • Delivery may take 1-3 business days, depending upon USPS closures/holidays/inclement weather.
              • Once the package has been submitted to USPS, a tracking number will be provided to you in the group chat.
              • Once the tracking number has been provided to you SSB/Kelli IS NO LONGER responsible for lost or damaged packages by USPS. 
              • Your package will be insured to the full amount you paid to SSB/Kelli Stone for services.
              • In the event of a lost package or damaged product(s), you are responsible for initiating and maintaining a claim with USPS to pursue reimbursement, as well as following all required prompts and protocols laid out by USPS, within any specified time frame given. 

               

            • Sacred Seasons Birth Order Form and Service Contract

              Please carefully review and complete the service contract below. The $75 non-refundable deposit is due at the time order form is submitted (if you are securing services ahead of your due date). The $75 deposit officially secures your place on the service schedule and DOES go toward your total balance due. If you are a same-day client, it is required that the entire balance due be remitted at the time you submit your order form. If you need clarification or assistance completing the order form, contact Kelli Stone immediately at 940-230-6690
            • I,   *   *, (henceforth "I"), have requested Sacred Seasons Birth/Kelli Stone (henceforth "SSB") to prepare my placenta, in capsule form, for my personal use. As a condition of service, I make the following assertions, freely and of my own volition.

              • I understand that results may vary for every woman and each of her pregnancies. As such, I acknowledge no guarantee of results is neither offered, nor implied, by SSB or its representatives.   *   


              • I release SSB, Kelli Stone, and all SSB representatives from all liability associated with any unwanted side effects I may experience after consuming my placenta products.   *      


              • I understand that services rendered by SSB are not intended to diagnose or treat illness or injury of any kind. SSB provides placenta preparation services, for personal use, only.   *  

                  

              • I understand that the FDA has not evaluated the statements made by SSB, Kelli Stone, or their representatives.   *   


              • I understand the guidelines provided for using my placenta products are for reference only. I assert I will listen to my body and adjust product usage according to my needs. *   


              • I understand consuming my placenta products during times of illness, such as the common cold, flu, mastitis, etc. may cause a worsening of my symptoms. I will stop using my placenta capsules until the symptoms of the illness subside.   *


              • I agree to disclose to SSB if Kelli Stone and/or their representatives will be exposed to any blood-borne pathogens or highly communicable diseases, such as but not limited to, HIV, Hepatitis, MRSA, etc. in the space provided above. I understand testing positive for any of the aforementioned or the presence of meconium at birth does not preclude me from encapsulating my placenta   *  


              • I agree to notify the birthing facility, via my nurse, at the time of admittance, that I am keeping my placenta, request for my nurse to chart that information (making it part of the legal record), and bring me any required placenta release paperwork to sign, as soon as possible. I agree that I or my support person(s) will assert my right to keep my placenta, as protected by H.B.1670, (a copy of which is at the bottom of this form to be printed off and taken with me to the birthing facility).   *       


                    

              • I agree to call Kelli Stone immediately if the facility, care provider, or nurse refuses to release my placenta or if I feel I may be at risk of having my placenta taken from me. *       


              •  I assert my placenta is properly stored in a leak-proof container, with a lid, or triple bagged, in sturdy plastic bags, buried in a minimum of 2 inches of ice, (both under the placenta and on top), in the disposable cooler, no more than 4 hours postpartum. I understand the placenta may be kept on ice (replenished every 8-12 hours or as needed) or refrigerated, up to 72 hours postpartum before it MUST go into the freezer.   *

                    

              • I agree to maintain possession of my placenta from the time of delivery through my stay at the hospital or SSB takes possession of it. I understand if my placenta is taken to the hospital lab, or stored anywhere other than in the possession of myself, or my designated representative, the proper chain of custody has been broken and my placenta at risk of cross-contamination (chemicals, blood, and other bodily fluids from other people, etc.), being lost, stolen, disposed of by the facility, or accidentally switched with another placenta not belonging to me.   * 

                   

              • I agree to pay the $75 nonrefundable deposit at the time of contract submission, via one of the approved payment methods stated within this form.    *      


              • I agree to notify SSB, immediately, if a payment plan (not exceeding more than four (4) installments) needs to be arranged. I understand payment plans are only available through the duration of my pregnancy and any remaining balance must be remitted, in full, at the time of delivery.   *


              • Same-day clients: I understand and agree to remit the full balance, not just the $75 non-refundable deposit, for services at the time I submit my order form. I understand SSB cannot dispatch to my location without the balance remitted in full.   *       

                     

              • I agree to notify Kelli Stone via a text message, in the designated group chat, of all pertinent updates regarding my labor and delivery progress. Things such as changes in the birthing location, I am in active labor and have been admitted to the facility, there was meconium present at the time of birth, etc., should all be conveyed as soon as possible. I understand I have direct access to Kelli Stone 24/7 and can contact her as needed.   *      


              • I understand I, or my support person, must call, not just text, Kelli Stone once the placenta has been secured and ready for transport.   *      


              • I agree to have my support person or otherwise designated representative meet Kelli Stone in the designated area outside of the facility with the placenta properly secured in a disposable cooler. SSB, Kelli Stone, and their representatives cannot return a hard-sided cooler once used to secure and transport the placenta, as it is unsanitary and goes against OSHA standards.   *   


              •  I have read, understand, and agree to the terms and conditions outlined herein and assert the answers are correct to the best of my knowledge.   *      

                *   Pick a Date*   

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