PLACENTA ENCAPSULATION CONTRACT & APPLICATION

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TEN MOONS BIRTH PLACENTA ENCAPSULATION TERMS & SERVICES

A Ten Moons Birth/Spread Your Wings Doula Care Representative will pick up the client’s placenta(s) at the agreed upon time and said client, to be outlined in the “Client Responsibility” section below. Proper cleanliness and preparation precautions for ingesting the placenta will be carried out by TMB to ensure the highest quality of placenta encapsulation possible for the age and storage methods of the placenta(s) before the encapsulation process. TMB will deliver the finished encapsulated placenta pills in a timely fashion to the place specified by the client.


CLIENT RESPONSIBILITY

It is the client’s responsibility to notify TMB/Tammy Mancuso as soon after the birth as possible, preferably the same-day as the birth itself, to request pick-up of the placenta(s) by TMB at the location previously agreed upon by both parties.
(Failure to do so may result in delayed placenta preparation and encapsulation and may cause decreased potency of nutrients, hormones, and other beneficial attributes of the placenta(s), and even spoilage of the placenta(s) which would render it unusable for encapsulation.)
It is also the client’s responsibility to discuss release of her placenta(s) after her birth from the establishment where she delivers and to ensure proper storage of her placenta(s) in a refrigerator or cooler with the placenta(s) placed on ice until it can be picked up or delivered to TMB for preparation and encapsulation.
It is also the client’s responsibility to inform TMB/Tammy Mancuso of any known blood-borne illness(es) or other health issues that I may become infected with through contact of bodily fluids (specifically maternal and fetal blood and amniotic fluid), such as HIV, hepatitis, STD’s, GBS+, etc.

PREPARATION METHOD

We offer steamed encapsulation. The placenta is then dried and put into capsules. 

TMB PLACENTA ENCAPSULATION INCLUDES

• Pick-up of placenta(s) at place of delivery.
• The full placenta preparation and encapsulation process.
• Proper storage container of the completed placenta pills.
• Digital instructions for proper storage and handling of the finished placenta pills.
• Suggestions for ingestion amounts.
• Delivery or shipment of the finished placenta pills to the client at the agreed upon location by both parties.

PLACENT OPTIONS (Choose 3/$20 per additional add-on)

  *placenta print on archival paper
  *cord art keepsake
  *tincture (for use after 6 weeks- supports menstrual symptoms)
  *12 Ghirardelli chocolates with dehydrated, ground placenta in it
  *wall art including 2 epoxy charms

FEES FOR SERVICES

TMB Placenta Encapsulation Package Fee comes to $200. Add-on Options chosen will be added to invoice for prices outlined above. Fee must be payed in full by the time of placenta preparation. Fee can be payed cash, via Venmo or PayPal.
After this form is submitted a TMB/Spread Your Wings Doula Care Representative will be in contact with you shortly to discuss payment if not already discussed.

SHIPPING AND TRAVEL FEES

There are no additional travel fees for clients within 30 miles of our facilities in Grand Junction, CO. Completed placenta capsules and goods either be shipped to clients 30+ miles away or delivered to previously agreed upon location. Client will cover shipping and handling, and you will receive your placenta within 1 week of initial pickup. Client will be invoiced the following fees if delivery is necessary. 

Travel Fee applies to each trip outside Mesa County related to Birth Doula Services.
Delta/Montrose $60.00 - Rifle $60.00 - Glenwood Springs $90.00 - Moab $120.00 - Ouray/Ridgway $120.00 - Telluride $145 - Aspen/Vail $145.00

REFUNDS + CANCELLATION

If the client chooses to terminate the contract, thereby voiding the agreement for placenta encapsulation by TMB/Spread Your Wings Doula Care, the client must contact TMB/Spread Your Wings Doula Care to terminate the contract BEFORE TMB/Spread Your Wings Doula Care acquires the placenta(s) originally intended for encapsulation in order to receive a full refund of any moneys paid to TMB by the client.
If the client decides that they does not want the finished placenta pills AFTER TMB/Spread Your Wings Doula Care has begun the encapsulation process, or if it the process has been completed, the client will not be refunded any moneys already paid to TMB and will owe TMB the balance of the fee previously agreed upon if the balance is still owed (i.e. no refund or waiving of fees will be made).

In filling out the form below, you agree that you have read and understand the Service Descriptions and Agreement for Ten Moons Birth Placenta Encapsulation Services and that you agree to the terms and conditions outlined therein, as well as the stated fee.

Placenta Encapsulation Application
 

Placenta Add-ons (Choose 3)

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