By submitting this form, I certify that I have asked Barb Davis or Mary Odell (birth | Fort Worth, bFW) to prepare my placenta in capsule form for my own personal use. As a condition of this service, I make the following assertions:
I agree that...
- I am paying for the encapsulation, salve and/or tincture service only.
- My placenta does not contain any transmittable diseases such as Hepatitis-B, -C or HIV/AIDS.
- At the time of release, I will determine that my placenta is healthy and suitable for encapsulation.
- While in my posession, the placenta will be handled in a manner appropriate for safe food preparation from the time of birth.
I understand that...
Infection in the laboring person or in the baby during labor or heavy meconium present during labor or delivery would be a contraindication for encapsulation. bFW does not determine whether my placenta should be consumed and makes no guarantee of my personal results from the capsules.
bFW picks up placentas during the business hours of 9am to 7pm. It is my responsibility to notify my specialist when I go into labor and to make storage arrangements for the placenta if I deliver outside of business hours.
bFW will strive to pick up my placenta within 24 hours of delivery. I understand that this may not always be possible and that I am responsible for making proper storage arrangements until it is available for pickup.
bFW may require an additional 12-24 hours to pick up my placenta on the following holidays: New Year’s Day, Easter, Memorial Day, 4th of July, Labor Day, Thanksgiving, Christmas Eve and Christmas Day. It is my responsibility to make storage arrangements for the placenta if I birth on any of these holidays.
bFW will strive to return the finished product to me within 72 hours of pick-up however, I understand this may not always be possible. No refund will be issued for delivery of the finished product beyond 72 hours of pick-up.
If we are unable to secure the release of our placenta or if the placenta is deemed unsuitable for encapsulation, birth | Fort Worth will refund any payment made, save $5 for processing, unless bFW has taken posession of the placenta.
No refund will be issued once bFW has taken posession of the placenta.
Please Note: There are a few local hospitals, Harris Southwest included, that will not allow you to move to your postpartum room unless your placenta has been picked up or taken off the premises. You will need to have someone that can take the placenta on ice in your cooler to your car or home until your specialist arrives for pick-up. We pick up placentas between the hours of 9a-7p but may have flexibility - always let us know when your placenta is ready for pick up, regardless of the time.
Client Responsibility
It is your responsibility to inform hospital staff that you intend to retain your placenta. You should plan in advance for any requirements of your birthing facility for release, transportation or refrigeration of your placenta.
It is your responsibility to notify bFW as soon after delivery as possible so that we may make arrangements to prepare your placenta in a timely manner.
Fees
Fee for services is $295. This includes placenta capsules, cord keepsake (when possible) and an archival-quality placenta print.
Please note: A $50 travel fee is incurred for travel beyond 50 miles of 1301 Pennsylvania Ave, Fort Worth, TX