Placenta Encapsulation Contract

Placenta Encapsulation Contract

Complete this form to hire Sincerely Luna (Encapsulator Luna, MA, CPE, RM). At the end of the filling out this form you will have the option to pay online. This is payable in full at the signing of this contract. Please apply travel fee in which applies to the pick-up location.
Client's*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Partner's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Home/Drop-off Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Placenta Pick-Up Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated Due Date*

MonthDayYear
Date
Which hospital will you be having your baby?*
Have you informed your provider/midwife about keeping your placenta?*

YesNo
Name of Provider/Midwife/Doula?*
Have you had or do you suffer from any of the following; Group B Strep, Herpes, Lupus, PUPPP, Rubella/Congenital Rubella?*
Have you ever tested positive for HIV/Hep C/Hep B? If so please consult with us before making a payment*
Do you have any allergies?*
Have you smoked regularly through your pregnancy? If so, please state how many per day & when you stopped if you have stopped*
Please list any medication you are currently taking
Can we upload anonymous pictures/videos of your placenta to our social media channels?

YesNo
If you will like for us to tag you on social media (Instagram), please provide us with your instagram name.
Who can we thank for referring you to Sincerely Luna Placenta Specialist?
Services Provided

The encapsulator agrees to provide the following services:
- Placenta pickup from the client's designated location.
- Safe transportation of the placenta to the encapsulator's facility.
- Professional placenta encapsulation, following established safety and sanitation guidelines compliant with applicable regulations, including New York state regulations, OSHA standards, and food handling guidelines.
- Proper storage and labeling of the encapsulated placenta.
- Delivery or arrangement for the client to receive the final encapsulated placenta product.
The Process

Encapsulation or Powder Form:
- Your encapsulated placenta will take 5 consecutive days to prepare and the preparation will start within 48 hours of the birth.
- The placenta will be cleaned, steamed, and dehydrated.
- The dehydrated placenta will be then ground up and put into capsules.
- There is no guarantee as to how many capsules your placenta will yield. You can expect between 75-250 capsules or powder form yield can very.
- The amount of capsules varies as does the size of the placenta.
Tincture:
- Clean glass jar, fresh placenta, high-proof alcohol (40% or higher).
- A small piece of Placenta into the jar.
- The label will have the date and any relevant information.
- Infusion period: Store the jar in a cool, dark place for at least six weeks (or longer for a stronger tincture).
- After the infusion period, strain the tincture into another clean jar using a fine mesh strainer or cheesecloth.
Tools that work:
- A funnel and an unbleached coffee filter.
- Seal the jar tightly and label it.
- Store the placenta tincture in a cool, dark place away from sunlight or heat.
Tools will be provided for tincture.
Payment Terms

The total cost for the placenta services starts at $200+, payable in full upon signing this contract including additional add-ons.

Payment shall be made as follows:
- The client shall remit the full payment + additionals to the encapsulator on or before 2 weeks before their due date.
- Failure to submit the payment in full by the specified due date may result in a delay in the provision of services.
- All payments made are non-refundable.
Client's Responsibilities

The client agrees to:
- Provide accurate and truthful information regarding their health and medical history.
- Follow any storage and transportation instructions provided by the encapsulator.
- Acknowledge and comply with all applicable regulations, including New York state regulations, OSHA standards, and food handling guidelines related to placenta encapsulation services.
Safety and Sanitation

The encapsulator agrees to adhere to strict safety and sanitation guidelines during the encapsulation process, including but not limited to:
- Compliance with applicable New York state regulations, OSHA standards, and food handling guidelines.
- Proper use of personal protective equipment (PPE), such as gloves, masks, and gowns.
- Adherence to hygienic practices, including handwashing and equipment sterilization procedures.
- The encapsulator warrants that they are knowledgeable and trained in placenta encapsulation techniques, following best practices to ensure a safe and quality product while complying with all relevant regulations.
Liability and Disclaimer

The encapsulator shall not be held responsible for any adverse effects or outcomes resulting from the ingestion or use of the encapsulated placenta. The client acknowledges that consuming the placenta is a personal choice and that they should consult with a healthcare professional before doing so.
Confidentiality

Both parties agree to maintain the confidentiality of any personal or medical information shared during the course of the service. Personal information shall not be disclosed to third parties without the express written consent of the disclosing party.
Ownership and Disposal

The placenta remains the property of the client throughout the encapsulation process. Any unused or leftover materials will be returned to the client or disposed of according to the client's instructions.
Termination or Cancellation

Either party may terminate this contract in the following circumstances:
- Non-payment by the client
- Breach of contract by either party.
- Mutual agreement to terminate.
Dispute Resolution

In the event of any disputes arising from this Contract, both parties agree to first attempt to resolve the matter through good-faith negotiation. If negotiation fails, the parties may seek mediation or arbitration as an alternative dispute resolution method.

By signing below, the parties acknowledge that they have read and understood this Placenta Encapsulation Contract and agree to be bound by its terms and conditions.
Signature*

Clear
Date*

MonthDayYear
Date
Please get in touch with me with any questions or concerns,

Email: Sincerelyllunaa@gmail.com or Phone:(929) 352-3910

Website: Sincerelylluna.com

FAQs: Sincerelylluna.com/encapsulatedplacentafaq

My Products,

Encapsulated Placenta & Tincture Set Product Image

Encapsulated Placenta & Tincture SetCan choose either TCM or Raw for the encapsulation, 2 oz tincture, and Keepsake are included. *Note: Pink and red capsules are in stock. Vegan capsules are also available, with a potential additional charge.

$325.00 Capsules ColorPreparation MethodTincture

Encapsulated Placenta (TCM) Product Image

Encapsulated Placenta (TCM)The Chinese Method involves steaming the placenta with various herbs, such as ginger and lemon, before dehydrating and grinding it into a powder for encapsulation. *Note: Pink and red capsules are in stock. Vegan capsules are also available, with a potential additional charge.

$275.00 Capsules Color

Encapsulated Placenta (Raw) Product Image

Encapsulated Placenta (Raw)The raw method involves skipping the steaming step and dehydrating the placenta directly before grinding it into a powder for encapsulation. *Note: Pink and red capsules are in stock. Vegan capsules are also available, with a potential additional charge.

$275.00 Capsules Color

Encapsulated Placenta (50/50) Product Image

Encapsulated Placenta (50/50)The combination method combines aspects of both the TCM and raw methods.*Note: Pink and red capsules are in stock. Vegan capsules are also available, with a potential additional charge.

$325.00 Capsules Color

Pure Placenta PowderThe raw method in powder form involves skipping the steaming step and dehydrating the placenta directly before grinding it into a powder.

$235.00

Placenta CremationFacing medical constraints that prevent placenta consumption? Our service provides a heartfelt and distinctive solution to honor this precious Placenta. By transforming your placenta into ashes, you can lovingly scatter it back into mother nature.

$235.00

Placenta TincturePlacenta tincture is a liquid extract made from the placenta, believed to support postpartum recovery and hormonal balance.

$40.00 SizePreparation Method

Placenta SmoothiesPlacenta smoothies are beverages made by blending small amounts of raw or cooked placenta with various fruits, vegetables, and liquids. (Smoothies Sets are available. Amazing during meal prepping or during your first week at home)

$150.00

Frozen Placenta PiecesFrozen Raw pieces of placenta to make your own smoothies at home for once a day. (ICE TRAY INCLUDED)

$60.00 Quantity

KeepsakeHydration of umbilical cord into a keepsake.

$30.00

Travel FeePlease select for drop-off/pick-up fee

$50.00 Select Fee

Deposit Fee A deposit will be required to secure your spot in my schedule. Discount codes do not apply. Will be reduced from the subtotal. (Non-refundable)

$50.00

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Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

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