Hi, Thanks so much! Will definitely let people know how awesome you have treated us and answered questions! This was our first encapsulation experience, thanks for making it a great one! -Stephanie R. 10-28-14
Placenta Encapsulation Fee: $200
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Placenta Encapsulation Agreement/Contract
Placenta Encapsulation is the process of preparing the mother’s placenta after the birth of her baby by dehydrating, powdering and placing it into capsules for the mother to ingest.
Limitations and Disclaimer
I am not a licensed medical professional and I am 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 ascribed benefits are supported by evidence-based research, but none have been evaluated or approved by the FDA. It is your responsibility to determine whether using placenta preparations may be of benefit to you. ________ (initial)
I will pick up your placenta at an agreed upon time and return completed capsules to you within 72 hours. The jar with your pills in it will have dosing and handling guidelines
It is your responsibility to notify me as soon as possible after the birth to make arrangements for transfer of your placenta to me. Failure to do so may result in delayed placenta preparation and encapsulation and can cause decreased potency of nutrients, hormones and other beneficial attributes of the placenta. Improperly handled placentas are susceptible to spoilage and all placenta work is done at your own risk.
It is your responsibility to discuss the release of your placenta with your primary health care provider as well as the facility you will be birthing in. Please make sure your placenta is refrigerated or kept on ice until it can be picked up or delivered for preparation and encapsulation.
Your placenta may be kept at room temperature for 3-4 hours following your birth. After that, or as soon as possible, it should be placed on ice or in a refrigerator. If it is going to be 3 or more days before your placenta can be processed, it should be frozen. A frozen placenta may require 1-2 additional days for processing since it must be gently defrosted prior to being dehydrated.
The fee for this process is $200. Payment is due before I begin processing your placenta—either during pregnancy or upon the pick-up of your placenta.
Checks can be made payable to Katherine Bentley
In the event your placenta is unavailable ie. you receive medical treatment that renders the placenta unusable, or you change your mind prior to releasing your placenta to me – any fees you paid me in advanced will be refunded in full. Once you release your placenta to me there will be no refund, even if you choose not to take the finished capsules.
Fill in the circle to choose your method
Traditional Chinese Medicine (TCM) – In this method, your placenta will be steamed with ginger and lemon before dehydrating. This is to enhance its warming properties and help your body use the beneficial properties of the placenta in a deeper way. This method also kills any bacteria and reduces risk of spoilage.
Raw Dehydrated Method – this method involves slicing the placenta while fresh and raw and dehydrating it immediately. Women who choose this method consistently report increased energy as one of the benefits. It is widely held that the hormones are more likely to be bioavailable when the placenta is processed raw. Some say that raw dehydrated pills will not stay potent for as long as TCM pills for using during menopause.
_____________ (initial) I DO/DO NOT(CIRCLE ONE) give permission to Katherine Bentley to photograph my placenta before during and after processing and use those photographs as she desires for marketing, advertising, educational or promotional reasons in print or on the internet.
Client Signature: __________________________________