Placenta Client Intake Form

Please include the address if you have it, if not then at the very least the city so I can find it 😊 *️⃣ +$40 travel fee if outside of Modesto.

You'll receive your completed package 48-72 hours after pick-up

I mainly ask this so you can think about who you want to do this so you can ask that person ahead of time

✨ Encapsulation is $300 but only a $100 nonrefundable deposit is due within 7 days of submitting this form to secure your due date. Don't want to consume your placenta but still want art keepsakes? ✨ The NON-Consumptive package is $180, so you'd still receive everything stated except for the pills and tincture. If you'd like your placenta dehydrated for burial and not for consumption then it will be $250 ✨ If you are my birth doula client, the cost of the consumptive package is $180. The full amount is due before your due date or before the pick up of your placenta from your birth location, whichever comes first. Pay in full and you receive a free placenta tincture and free postpartum herbal sitz bath satchels ($50 value) *️⃣ What I mean by paid in full = $300 total and all $300 paid at one time, doesn't apply to payment plans. Once I receive this completed form, I'll send you the invoice so you can pay.

Remember: If you are paying in full then disregard because you'll already get both included. HERBAL SITZ BATH BENEFITS: This organic herbal bath is for helping to speed up healing and reduce swelling in your perineum. But that's not all - this multi-talented blend can be brewed for use in a sitz bath, peri bottle, bathtub, or even turned into a refreshing padsicle. Having/Had a Cesarean birth? You can still use it - just brew a batch and use in your tub once you've been cleared for a soak. Suffering from hemorrhoids? This blend will also bring much-needed relief. And if you're all healed up but still have some herbs left? Just pour the remaining herbs into a bowl, add boiling water, and enjoy a relaxing facial steam or hot cup of tea. Because self-care is always important. PLACENTA TINCTURE: Tinctures are liquid extracts with a substance dissolved in them, such as your placenta. They are extracted in 100-proof alcohol. The tincturing of the placenta in high-grade alcohol can increase the length and benefits of your placenta for both you and your child. The tincture can be used in any time of trauma, transition, and emotional distress to ease your symptoms once your placenta pills are all used up. When properly cared for it can last a lifetime! Top 10 Benefits: 1. Balance postpartum hormonal fluctuations 2. Help reduce symptoms of PMS 3. Soothe indigestion for mom and baby 4. Decrease insomnia and sleep disorders 5. Ease childhood infections (rashes) 6. Reduce colic and teething in baby 7. Aids in trauma, transition, emotional distress (weaning, growth spurts, etc.) 8. Stabilize moods 9. Ease anxiety and emotional distress 10. Ease cough, stuffy noses, and other cold-like ailments

Raw Method: Dehydrated, yields more capsules Traditional Chinese Method (TCM): Steamed & dehydrated- fewer capsules If you choose the Raw Method, it could change to TCM if you develop or have certain conditions. If you have any questions don't hesitate to ask. Check out this blog post to learn more about the methods. Copy and paste to your search browser if the link isn't working: https://birthingcometrue.com/blog/7 *️⃣ If not consuming then click the appropriate box

My hours of pick-up are from 6 am- 9 pm so plan to have the placenta put in your refrigerator ASAP (within 3-4 hours) after you give birth. If birthing in the hospital plan to have a backup pick-up person as I could also be at a client's birth. If the placenta is taken out of your sight or out of your room I CANNOT encapsulate it as it could have been contaminated or improperly handled. If I am your birth doula, I will ensure your placenta is in the proper temperature environment. Please check 'yes' if you agree.

You receive a birth announcement keepsake with your baby's name on it 🎉 You can fit two names on this keepsake plus an animal, flower, or other design, see picture for an example. Example: First and Last name OR First name and Middle name, your choice. If you haven't decided on your baby's name or are deciding after your baby is born then just let me know when you do decide and you'll still receive it. Just write "No Name" in the space below. *️⃣ Please double-check spelling before submitting as it cannot be changed once the order is placed. Here's an example of the keepsake https://drive.google.com/file/d/1XzE64wyCq_5AjrNByPb6wPOS8gBQJP6b/view?usp=drive_link

I may have to deny potential placenta clients so I can process yours (I only process 1 placenta at a time for safety and health reasons) so that's why I don't offer a refund. The hospital CAN'T take your placenta without your consent so it's your duty to advocate for your rights & your placenta. If you develop an infection or discover any other anomalies then I can still create an umbilical keepsake, and placenta print for you. I'll give you some tips and a form you can hand to the medical staff beforehand but if need be, I'm willing to personally talk to hospital staff to help you assume possession of your rightful property aka your placenta 😊 *️⃣ If I am your birth doula, I would talk to hospital staff and advocate for your placenta.