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Placenta Encapsulation Registration Form for Oklahoma City and Nearby.

This form takes just a few minutes to complete.

Haga clic aquí para ver este formulario en español.

Welcome to Peace of Mommy Encapsulation

Congratulations on your pregnancy! We're so excited to be part of your postpartum journey. Please take a few minutes to complete the registration form so we can gather the information needed to prepare for your placenta encapsulation service.


Service & Payment

The total cost is $375, which includes our placenta encapsulation service, a free umbilical cord keepsake and placenta hospital pick-up.

A $150 deposit is required to secure your spot on our schedule. This deposit goes toward your total balance of $375. The remaining balance is due before we pick up your placenta. Please note that we must receive the remaining payment before we head to the hospital for placenta pick-up.

Once we have your placenta, placenta encapsulation process takes 2–3 business days.


Whether you’re currently pregnant or already in labor, it’s never too late to book with us! We do our best to accommodate everyone, no matter how far along they are in their pregnancy. Feel free to call us at 405-414-1783 with any questions. Our placenta pick-up hours are Monday through Friday, from 9:00 AM to 2:00 PM. If you need to arrange pick-up outside of these hours, please be sure to follow proper storage instructions until we are able to retrieve your placenta.


Hospitals within our pick-up radius:​

  • INTEGRIS Health Baptist Medical Center

  • Oklahoma Children's Hospital OU HEALTH

  • St. Anthony Hospital - Joyful Beginnings Birthing Center

  • Mercy Love Family Women's Center

  • Lakeside Women's Hospital

  • INTEGRIS Health Southwest Medical center

  • INTEGRIS Health Edmond Hospital (Edmond)

  • INTEGRIS Health Canadian Valley Hospital


Not included in our Radius:

  • Norman Regional Healthplex Hospital (Norman)

  • SSM Health St. Anthony Hospital (Shawnee)

  • Stillwater Medical Center (Stillwater)

  • INTEGRIS Health Enid Hospital (Enid)

  • Duncan Regional Hospital (Duncan)

  • Chickasaw Nation Medical Center (Ada)

  • Mercy Hospital (Ardmore)


If your hospital is not in our radius, you are responsible for bringing your placenta to us. Placenta drop-off is by appointment only.  Please notify Peace of Mommy in advance when you plan on bringing your placenta. We also offer a shipping option for $100 extra. Please complete the nationwide form to ship your placenta. Click here.


Refund:

In the event your placenta is unavailable to you or you choose to terminate services, a $75 deposit fee will be deducted.


Please check all the boxes that apply. Find description for each product by clicking here. Boxes that are left unchecked will not be added to your order. Once we review your form, we'll send you a scheduling confirmation email and invoice with remaining balance.

Services:
Umbilical Cord keepsake Color (if applicable):

Can be any two colors (no metalic colors included).

Multi-line address

If you don't know yet, or don't remember leave blank.

What is your estimated due date?
Month
Day
Year

We understand due dates are not 100% accurate. We just need an estimated date.

Permission to photograph/video your placenta? Your name won't be displayed.

We'll get back to you.

I understand that if I test positive for Group B Streptococcus (GBS), I can still keep my placenta for encapsulation because the process at Peace of Mommy includes exposing the placenta to high temperatures, which eliminates potential viruses and bacteria
I understand
I understand that THE ONLY reason my placenta is unsafe to encapsulate is if I have AIDS/HIV Positive
I understand
I understand that it is my responsibility to properly store and keep the placenta chilled until pick-up.
I understand
I understand that if I need to take my placenta home, I am responsible for keeping it **frozen** and bringing it to Peace of Mommy. **Placenta drop-off is by appointment only.** I must notify Peace of Mommy in advance when I plan to bring my placenta.
I understand

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 the day of your delivery.

If possible notify us when you are in labor and again as soon as possible after birth to make arrangements for transfer of your placenta to us. Improperly handled placentas are susceptible to spoilage.

If they schedule you for induction or C-Section please let us know the date and time.

Clients are responsible for ensuring proper storage and care of the placenta until pick-up. The placenta must be handled like a fresh food product and kept properly chilled to maintain freshness and safety. If you deliver outside of our pick-up hours and take the placenta home, you are responsible for bringing it to our location in Edmond. We do not provide home pick-up services. Pick-Up Notification Please text or call 405-414-1783 when your placenta is ready for pick-up. We will provide an estimated pick-up time based on availability.


How to go about asking to keep your placenta:

Some women like to let their health providers know ahead of time but it's not necessary. The day you deliver your baby, before you go into labor simply let your nurses know that you'll be keeping your placenta and that you've made arrangements for someone to come pick it up after your delivery. You do not have to ask for permission to keep your placenta. IT IS YOUR ORGAN!


Placenta Collection:

By scheduling placenta processing services, you acknowledge and agree to the following placenta pick-up and storage requirements: Pick-Up Hours Placenta pick-up is available Monday through Friday from 9:00 AM to 2:00 PM. If your delivery occurs outside of our scheduled pick-up hours, you are responsible for following proper storage procedures until your placenta can be retrieved. 


Storage:

Your placenta may remain at room temperature for up to 3–4 hours after delivery.

  • After 4 hours, the placenta must be placed in a sealed container or ziplock bag and stored at 30–40°F (normal refrigerator temperature). 

  • The placenta must remain properly refrigerated or stored on ice in a cooler until pick-up is available.

  • If the placenta is kept properly chilled, on ice in a cooler where the ice isn't fully melted, it's generally okay until the next morning (cooler storage 1 day only).

  • For extended storage periods, including weekends or delays in pick-up, the placenta must be frozen until it can be picked up or delivered.

  • Beyond that, the placenta is good in the fridge for up to 3 days. After 3 days, it must be transfer into the freezer.


Hospital Storage Instructions

Many hospitals will provide a sealed container and ice for placenta storage. If the hospital stores your placenta in their refrigerator, you are responsible for ensuring the container is clearly labeled: “DO NOT TAKE — PATIENT IS TAKING HOME.” We strongly recommend bringing your own cooler to the hospital and keeping your placenta in your room whenever possible to help prevent misplacement or accidental disposal.

​

Weekend Deliveries & After-Hours Pick-Up

If you deliver during the weekend or outside of our pick-up hours, you may: 

  • Keep your placenta in a cooler with ice until pick-up is available; 

  • Have the hospital store your placenta according to proper refrigeration guidelines; or

  • Have someone take the placenta home and place it in the refrigerator or freezer. ​


Picking up your pills:

If you choose to pick up your pills in person, you will be notified when they are ready, typically within 24–72 hours after your placenta is received.

Please pick up your pills promptly after receiving your notification. We are unable to hold prepared pills for more than one week after they are ready for pickup.

Because we are frequently in and out of the office, we ask that you let us know when you plan to pick up your pills. Pickups are by appointment only so we can ensure someone is available to meet you.

Situations when your placenta may be sent to pathology include:

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.


• Birth complications – If you had birth complications, hospitals may want to test your placenta. In this case, request that they take only a small sample for testing, not the entire placenta. Whole placentas sent to pathology are often exposed to chemicals and are not safe for consumption.

Other:

• Positive GBS test – Even if you test positive, our method of steaming at 160-180°F and dehydrating at 160°F for 12–24 hours kills all bacteria (including GBS). Encapsulation is still safe.

• Meconium staining – Meconium itself is sterile and does not make the placenta unsafe.

Preeclampsia is not, by itself, a contraindication to placenta encapsulation. In most cases, the placenta can still be safely encapsulated unless there are other medical concerns."


When it is not safe to consume:

• Hepatitis

• AIDS

• HIV

• Active infection



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 not FDA approved, such as dietary supplements, herbal supplements, and natural remedies).


Refunds & Cancellations:  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.

• $75 of the $150 initial payment is non-refundable, as it reserves your spot and covers preparation and payment processing fees.

• If your placenta has already been picked up or encapsulated, no refunds can be issued, as your service is already underway and materials have been used.


By signing below, my permission is granted for your specialist to transport your placenta for preparation and delivery of completed 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.


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Registration deposit payment

If you're having trouble submitting the form, please try submitting from a different browser. Once payment is submitted, if you choose to cancel or terminate services, a non-refundable $75 deposit will be applied.

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