By submitting this form, I certify that I have asked Barbara Davis and/or Rachael Ibarra (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 and/or tincture service only. My placenta does not contain any transmittable diseases such as Hepatitis-B, -C or HIV/AIDS. My care provider and I have determined that my placenta is healthy and suitable for encapsulation. The placenta has been handled in a manner appropriate for safe food preparation since the birth.
I understand that...
Infection 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 them 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 36 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 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 deliver on any of these holidays.
bFW will strive to return the finished product to me within 48 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 48 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, unless bFW has taken posession of the placenta.
No refund will be issued once bFW has taken posession of the placenta.
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.
Fee for services is $225. This includes placenta capsules, cord keepsake (when possible) and an archival-quality placenta print.
Please note: a $50 travel fee will be incurred for travel beyond 30 miles of our office at 4255 Bryant Irvin Rd. Fort Worth, TX.