Nationwide Placenta Encapsulation Registration Form

This will take a few minutes to complete. We require a $200 upfront payment to schedule our services and to ship our placenta shipping kit. In the event your placenta is unavailable to you or if you choose to terminate services, you will be entitled to a refund minus a $100 scheduling fee. Placenta shipping kit must be sent back in order to receive refund.

A confirmation email with more information regarding your placenta and placenta shipping kit will be sent to you once you complete this form and your payment of $200 is successfully made.

Whether you're currently pregnant or in the midst of labor, it's not too late. Simply, take your placenta home and keep frozen until your placenta shipping kit arrives. If you are 36 weeks along or further, we'll expedite the shipping process to ensure timely receipt of your kit.

Our Capsules - ($400): At Peace of Mommy Encapsulation, we specialize in placenta encapsulation using The Steamed method of preparation. This method is designed to eliminate any potential bacteria, including group B strep. The process involves seasoning the placenta with lemon juice, cayenne pepper, and ginger. The placenta is then steamed by subjecting the placenta to temperatures higher than 140 degrees F. Once Steamed the placenta is cut into pieces and dehydrated for 24 hours, we then grind the placenta into fine powder and place it into gelatine capsules. We offer both unflavored and flavored capsules being an excellent choice for individuals who struggle with taking supplements. Depending on the size and density of the placenta, our service typically yields 110-200 capsules, ensuring that new mothers have a substantial supply of placenta pills to support their postpartum recovery.

Placenta shipping kit - (included):

Your shipping kit will include:

• A cardboard box to ship your placenta (this will be the

  same box you receive your shipping kit in)**please

  remove existing shipping labels. If the box arrives damaged let us know and we’ll send new one. You can use your own box too.

• An ice chest.

• XXL ziploc bag.

• 2 biohazard ziplock bags.

• A leak proof container with lid (please note: once you

  close the container with lid, it will not open again. It’s best for you to close it when doubled bagged placenta is in it.)

• 4 gel packs.

• A large zip tie.

• A roll of shipping tape.

• Perishable stickers

• An overnight prepaid shipping label. You don’t have to pay for

  shipping. Simply drop off at UPS store.

Umbilical Cord Keepsake - (free): At no extra cost, we dehydrate the umbilical cord into a heart shape with color of your preference.

Placenta Tincture - ($30): Comes in a 2 oz dropper glass bottle. The tincture is made by soaking a small piece of fresh placenta in strong alcohol; the benefit to having a tincture made is that it can be used in addition to and long after the capsules are gone. By tincturing a small piece of the placenta in a high grade alcohol, the length and benefits of your placenta for is increased. Some clients also give the tincture to their children in times of illness or transition. The tincture can be used in any time of trauma, hormonal imbalance, trauma, emotional distress and for mother later in life during menopause.

Placenta Balm - ($30): Comes in a 5.1 oz tin jar. Placenta salve can be used to heal C-Section incisions, lessen scarring, itching and discomfort. It can also be used for hemorrhoids, perineal tearing, burns, baby diaper rash, eczema, stretch marks and skin irritation.

Ingredients: Coconut oil, almond oil, Shea butter, comfrey leaf, calendula petals, beeswax, plantain leaf, placenta powder.

Placenta print - ($25): The placenta print is the print of your placenta using food grade water colors. This is printed in a 11" x 15" watercolor paper.

CLIENT RESPONSIBILITY:

It is your responsibility to discuss the release of your placenta the day of your delivery with your primary health care provider as well as the facility you will be birthing in. Your placenta may be kept at room temperature for 3­-4 hours following your birth. After 4 hours it needs to be in a sealed container or ziplock bag, and it needs to be chilled at 30-40 degrees.

Day you deliver your baby: bring the ice chest, the 2 biohazard ziplock bags and the leakproof container. You will give the 2 biohazard bags and the leak proof container to your nurse and tell her, “I am taking my placenta home, can you please double bag the placenta inside the two biohazard ziplock bags and place it into the leak proof container.” PLEASE, make sure they double bag the placenta inside the biohazard ziplock bags before placing placenta inside the leak proof container. The placenta has to be double bagged so there aren’t any leakages during transit. If they have their own biohazard bags it’s okay for them to bag the placenta with those and then place it in the container, just make sure they are sealed. Once you delivered your baby, they will have you sign a release form and will then give you your placenta in the leakproof container. You will then place your placenta inside the ice chest and keep it in there with ice, make sure the ice is not melted at least every 4 hours (the hospital will provide ice). Once your placenta makes it home, place it in the freezer (we want to make sure your placenta is rock hard frozen before shipping).

It is important to note that there may be circumstances under which your placenta can not be used. Significant abnormalities of the placenta may necessitate your doctor or midwife sending your placenta to Pathology for further examination. Please call us as we can consult with you before proceeding with any decision they make regarding your placenta.

LIMITATIONS AND DISCLAIMER: We are not licensed medical professionals and We are not able to diagnose, treat or prescribe for any health condition. Services and fees are for the preparation and encapsulation of your placenta, not for the sale of the pills. No specific benefits or effects are promised. Benefits will vary from person to person. Many of the benefits are well supported by evidence based research; but none have been evaluated or approved by the FDA (all holistic medicine is usually not FDA approved, such as dietary supplements, herbal supplements, and natural remedies).

REFUNDS: In the event your placenta is unavailable to you (ex. sent to Pathology and not released), if you choose to terminate services, or if your placenta has been contaminated with a bacterial infection, you will be entitled to a refund minus a $100 scheduling fee. Note that your shipping kit must be sent back to us before refund can be processed.

There will be no refund and remaining balance will be due once preparation of your placenta has begun, even if you choose not to take delivery of the finished capsules.

Your placenta will be handled and encapsulated according to OSHA bloodborne pathogens universal precautions and Food Safety and Handling standards. Your placenta will be cleaned, steamed, dehydrated and put into capsule form in the sanitary and disinfected work space indicated above. I understand that upon receiving the pills, my placenta specialist is no longer liable, including but not limited to any other person(s) ingesting my own placenta capsules. Peace of Mommy Encapsulation does not determine whether my placenta should be consumed and makes no guarantee of my personal results from the capsules. The capsules should not be taken during times of illness, such as the common cold, flu, or mastitis. I understand that taking the capsules in any manner other than as labelled can have undesirable results. We keep this document on file as a record of our agreement. No copies will be released to any third parties.