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Nationwide Placenta Encapsulation Registration Form

This form will take a couple minutes to complete.

Service & Payment

The total cost is $450, which includes placenta encapsulation, a complete shipping kit with a prepaid overnight label, and all shipping costs.

A $225 deposit is required to secure your shipping kit and reserve your spot on our schedule. This deposit goes toward your total balance of $450. The remaining balance is due once you ship your placenta. Please note that we must receive the remaining payment before beginning the encapsulation process.

Once received, 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, you will receive a refund minus a $100 scheduling fee.


After submitting this form and completing your $225 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 405-731-5972.

Please check all the boxes that apply. Boxes that are left unchecked will not be added to your order. Once we review your form, we'll send you an invoice with remaining balance
Umbilical Cord keepsake Color (if applicable):

Can be any color, we try our best to match it.



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

We'll get back to you.

Enter Referral Code & name of the person who gave you the gift voucher.

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).

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.


Situations when your placenta may be sent to pathology include:

• 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.


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 is possible in the following situations, but a $100 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 the encapsulation process has started.

  • 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.


Claiming Your Placenta Pills:


If no payment is received once your placenta arrives, you have four weeks to make payment. If you do not contact the company within this time frame, 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 $100 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 by sharing tracking number.
I accept
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
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You will receive an invoice with the remaining balance. This will be due once we receive your placenta.
$225

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Spring Creek Village Shopping Center, 1489 E 15th St Suite 116E, Edmond, OK 73013 

Booking online only - No Walk-ins Accepted

405-731-5972

Placenta Capsules do not replace medical care and should not be used to treat severe anemia, inadequate milk supply, and severe ppd.



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