• Sign up for Placenta Services Now!

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  • Estimated Due Date*
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  • Is this your first birth?
  • Do you have any infectious diseases such as HIV/AIDS, Hepatitis, Herpes, Lyme?*
  • Contract

  • Please Check each box once you have read and agreed to it. A check will represent clients initials.*
  • Preparation Method*
  • The Traditional Method used to be called the Traditional Chinese Medicine Method because it is steamed over water that includes lemon, ginger and hot peppers. You may decline any or all of these ingredients. Nothing is added to the placenta, only the water, so it will not be included in the capsules. *
  • Capsule Type*
  • Placenta Tincture. It is my opinion that every mama should order a placenta tincture. With this tincture you can enjoy the benefits of your placenta all the way into your menopause years. It lasts forever!!*
  • Are you interested in a Placenta Print?*
  • Photo Release*
  • Consent to Statistical Data*
  • My Order:*

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                    DEPOSIT ONLY!! Do not check any other box besides this box to make your $50 deposit to reserve your spot on my Calendar. DO NOT check this box if you want to pay in full now. Product Image

                    Placenta Capsules Product Image

                    Placenta Tincture (Highly Recommended!) Product Image



                    Pregnant with multiples?  Product Image

                    Strawberry Flavored Gelatin Capsules Product Image

                    Placenta Print Product Image

                    Free Umbilical Cord Keepsake Product Image

                    Free Digital Photo Product Image


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