Register for placenta services!

Placenta Encapsulation - Temecula Murrieta San DiegoIf you’ve read through my placenta services info, don’t have any additional questions, and are ready to proceed with booking your services, you’re in the right place! Go ahead and fill out the form below, and you will then be directed to a page to make your deposit. :0)

GENERAL INFO

 
Mom's Name*:
Partner's Name*:
Email*:
Confirm Email*:
Mom's Cell Phone #*:
Partner's Cell Phone #:
Address*:
   
Baby's Due Date*:
Birth Location*:
I am expecting:  A girl! A boy! A surprise!
Our baby's name is:
   
   

PACKAGE

 
I would like the: [radio* package "Premium Package - includes placenta encapsulation, 4oz placenta tincture, and cord keepsake." "Client/Student Premium Package - includes placenta encapsulation, 4oz placenta tincture, and cord keepsake (-$50)"]
   

PREFERENCES

 
Capsules: [radio* capsules "Regular gelatin capsules" "Vegetarian capsules (+$8)"]
Placenta Print: [radio* placenta-print "I would not like a placenta print" "I would like a standard placenta print" "I would like a placenta print with food-grade dyes (+$25)"]If yes, what color(s) would you like?
   

ADDITIONAL OPTIONS

 
I would also like:  Postpartum Consultation (+$40) Additional 4oz Tincture (+$10)
   

HEALTH

 
Does the mother have HIV/AIDS or Hepatitis A, B, or C? [radio* hiv-hepatitis-status "Yes" "No"]
If yes, please list:
Does the mother have any medical conditions that may affect her birth? [radio* medical-conditions "Yes" "No"]
If yes, please list:
Does the mother have any allergies? [radio allergies* "Yes" "No"]
If yes, please list:

CLIENT'S RESPONSIBILITY

 
   I will notify Maggie while I'm in labor and again within 2 hours after birth, so arrangements can be made for pick up, typically between 8a-10p.
 I will find out the proper procedure for the release of my placenta(s) from my birth location before my birth.
 I will make sure my placenta(s) is properly stored on ice in a cooler until pick-up.
 I will let Maggie know if any complications arise during labor (i.e. fever, infection, meconium). (Note: if there is fever or any other indication that the mother has developed an infection during labor, placenta consumption is not recommended and this contract will be considered void.)
 I understand that the capsules and tincture are intended for use solely by the mother who has birthed the placenta(s).
 

FEES

 
  Placenta services include travel to client’s birth location or home within 25 miles of Temecula for pick-up & drop-off, the full placenta preparation and encapsulation process, placenta tincture (4oz), cord keepsake, placenta prints (if chosen), proper storage container of the completed placenta pills, and written instructions for proper storage & handling of the finished placenta pills with standard suggestions for ingestion amounts. Fees are due in full when Maggie takes possession of the placenta(s). Mileage for travel outside of the 25 mile radius of Temecula (92591) will be charged a one-time fee of $1.35 per mile to cover gas and travel time.
 I understand and agree to the fee schedule.

REFUNDS

 
 
  • If the client chooses to terminate the contract, thereby voiding this agreement for placenta encapsulation by Maggie Jennings, the client must contact Maggie to terminate the contract BEFORE Maggie leaves to pick up the placenta. This is the only reason that fees will be refunded and/or the contract is considered void.
  • If the client chooses to terminate the contract after pick-up but contacts Maggie BEFORE the encapsulation process has begun, a handling fee of $50 will be owed to Maggie in addition to a mileage fee for travel. (If a greater amount than $50 has already been paid to Maggie by the client, Maggie will refund the difference.) Maggie will leave the non-encapsulated placenta(s) with the client so that the client may dispose of the placenta(s) properly.
  • If the client decides that she does not want the finished placenta pills AFTER Maggie has begun the encapsulation process or the process has been completed, no refund or waiving of fees will be made.
  • [checkbox refunds* "I understand and agree to the refund policy."]

   

DISCLAIMER

 
   I understand that benefits of placenta encapsulation have not been evaluated by the Food and Drug Administration (FDA). The services offered are not clinical, pharmaceutical, or intended to diagnose or treat any condition. Mothers who choose to utilize the services outlined in this contract take full responsibility for researching and using the remedies.
   
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