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Nationwide Placenta Encapsulation Registration Form

This form will take a couple minutes to complete.

Haga clic aquí para completar nuestro formulario de registro a nivel nacional (en español)

Service & Payment

The total cost is $475, which includes our placenta encapsulation services, a free umbilical cord keepsake, a complete shipping kit with a prepaid overnight label, and all shipping costs.

A $250 deposit is required to secure your shipping kit and reserve your spot on our schedule. This deposit goes toward your total balance of $475. 

The remaining balance must be paid before your placenta is shipped. If payment is not received, the process will not proceed and your placenta will be at risk of spoilage and will be discarded.


Once we receive your placenta, processing takes 2–3 business days. After completion, your capsules will be shipped promptly, and you will receive a confirmation email with tracking information.


Shipping Kit Includes

  • Cardboard shipping box

  • Insulated ice chest

  • 1 XXL ziplock bag

  • 2 gallon-size biohazards bags

  • Leakproof container with lid

  • 4 gel packs

  • Large zip tie

  • Roll of shipping tape

  • Prepaid overnight shipping label


Shipping kits are mailed between 34–36 weeks of pregnancy. If you are currently pregnant or in labor, it’s not too late—simply take your placenta home and keep it frozen until your kit arrives. If you are 36+ weeks, we will expedite shipping to ensure timely delivery.

If your placenta becomes unavailable or you cancel services before being shipped, you will receive a refund for your deposit minus a $125 scheduling fee.


After submitting this form and completing your $250 deposit (please allow 1–24 hours for processing), you will receive a scheduling confirmation email with detailed information about your placenta and shipping kit.

Questions? Call 405-414-1783


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, we try our best to match it (not metallics included0.



Multi-line address

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

What is your estimated due date?
Month
Day
Year
I understand that THE ONLY reason my placenta is unsafe to encapsulate is if I have AIDS/HIV Positive
I understand
Permission to photograph/video your placenta? Your name won't be displayed.

We'll get back to you.

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 (refrigerator temperature).


Situations Where It May Be Possible to Keep Your Placenta

There may be situations where your doctor or midwife recommends sending your placenta to Pathology, but you may still be able to keep it. If your provider recommends testing your placenta, please contact us before agreeing to send the entire placenta to Pathology. We can discuss the situation with you and help you understand your options.


Birth Complications

If you experience birth complications, the hospital may recommend testing your placenta. When possible, ask whether they can take only a small sample for testing instead of sending the entire placenta to Pathology. Whole placentas sent to Pathology may be exposed to chemicals or preservatives and may no longer be suitable for consumption.

Other Situations

  • Positive GBS Test: A positive GBS test does not automatically mean you cannot keep or process your placenta. Our standard process includes steaming and dehydrating the placenta which eliminates all viruses and bacteria. 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: Preeclampsia alone does not automatically mean your placenta cannot be processed. However, other medical concerns may affect whether it can be safely processed.



When it is not safe to consume:

• Hepatitis

• AIDS

• HIV

• Active infection


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).


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:

When You Can Get a Refund

A refund for your deposit is possible in the following situations, but a $125 scheduling fee will be deducted:

  • Placenta is Unavailable: This happens if your placenta is sent to a lab (Pathology) and is not released to you for the service.

  • You Terminate Services: If you decide to cancel the service before you shipped your placenta.

  • Placenta is Contaminated: If a bacterial infection is found on your placenta, making it unsafe to process.

  • Important Note: To get your refund, you must first return the shipping kit that was sent to you.


When You Are Not Entitled to a Refund


Once the encapsulation process has begun, you cannot get a refund and you will be responsible for the full payment. This applies even if you change your mind and decide you don't want the finished capsules.

  • Service is Underway: If the company has started to encapsulate your placenta, they will not issue a refund because they have already begun the service and used their materials.

  • We do not offer refunds for services impacted by shipping delays, carrier errors, weather conditions, or any other issue outside of our control. In the event of a delay, we will assess the condition of the placenta upon arrival and determine whether encapsulation is still possible and safe. If your placenta isn't good for consumption you will be entitled a refund minus $250 scheduling fee.

  • Our placenta shipping days are Monday-Wednesday. If a placenta is shipped or dropped off outside of our shipping days; Thursday through Sunday and arrives spoiled due to delayed shipping, the $250 deposit is non-refundable. If a package is dropped off at a UPS Access Point instead of an authorized UPS Customer Center or UPS Store as instructed, and the shipment is delayed resulting in spoilage, the $250 deposit is non-refundable. It is the client’s responsibility to follow all provided shipping instructions.


Claiming Your Placenta Pills:

Please note: The remaining balance must be paid before your placenta is shipped. If payment is not received, the process will not proceed and your placenta will be at risk of spoilage and will be discarded.

If we receive your placenta and payment has not been made and you do not contact the company , they will have to discard of your placenta for safety reasons.

This policy is in place to cover the company's costs and time once they've started the process, and to ensure they don't hold onto a client's placenta products indefinitely.


Shipping Delays & Liability:


We are not responsible for any delays, damage, or loss caused by the shipping carrier (including USPS, UPS, FedEx, etc.). While we provide prepaid overnight shipping and take all necessary precautions to ensure timely delivery, once the package leaves our hands, it is under the carrier's control. We do not offer refunds for services impacted by shipping delays, carrier errors, weather conditions, or any other issue outside of our control. In the event of a delay, we will assess the condition of the placenta upon arrival and determine whether encapsulation is still possible and safe. If your placenta isn't good for consumption you will be entitled a refund minus $250 scheduling fee.


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.

I agree to taking good care of the ice chest including my shipping kit until the day I ship my placenta to Peace of Mommy Encapsulation.
I agree
I accept the responsibility of gaining possession of my placenta, and notifying my placenta specialist when my placenta has been shipped email or text.
I accept
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 the importance of appropriate handling and storage of the placenta. Improperly handled placentas are susceptible to spoilage​ and all placenta work is done at your own risk​.
I understand
I understand that my placenta must be shipped **Monday through Wednesday** and dropped off at a **physical UPS Store location**. I understand that **UPS Access Points are not permitted**.
I understand
I understand that if my placenta arrives damaged, spoiled, or otherwise unusable due to being shipped outside these days or dropped off at an unauthorized location, my $250 deposit is non-refundable.
I understand
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Product

The remaining balance must be paid in full before your placenta is shipped.

If payment is not received, processing and shipment will not proceed. Delayed payment may result in your placenta spoiling, in which case it will need to be discarded.

If you're having trouble submitting the form, please try submitting from a different browser. Once payment is submitted, a non-refundable $125 deposit will be applied.

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