Placenta Encapsulation Client Form

Placenta Encapsulation Contract Form

Angie Hotz ~ (360) 808-3973 ~ Mothership Midwifery
Placenta encapsulation is the process of taking a fresh placenta and transforming it into a shelf-stable supplement for the mother to ingest. This encapsulation process includes full dehydration of the placenta, powdering the placenta after dehydration, and then putting the powder into capsules.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Estimated Due Date
Place of Birth
Please read the original placenta contract form below before agreeing to the terms.
There are two types of placenta encapsulation methods that include a natural method (also known as the raw method) and Traditional Chinese Method of preparation. I am happy to do whichever one that you prefer however I do think that the Natural method preserves more of the nutrients and therefore the one I recommend.

The TCM uses jalapeno, ginger, and lemon and the placenta is steamed with these before dehydrating and encapsulating. The Natural Method is dehydrated with no steaming involved in the process. Both are dehydrated at food safe high heats to ensure safety.

Both are dehydrated, powdered, and the powder put into capsules.
Placenta preparation options

Natural Method Placenta EncapsulationTraditional Chinese Method Placenta Encapsulation
Indicate if you are allergic to any of the following
**All placenta packages come with a framed placenta print, cord keepsake, and the placenta pills.

**Your placenta package will be delivered to you in aproximately 72 hours after picking up the placenta from you. (this is not guaranteed but the goal)
What colors do you prefer for the print? (my default colors are green, blue, and brown to look like a tree since the placenta is the tree of life) I have many colors and can do many combinations. What are your favorite colors?
Any other comments or things you would like me to know?
Please indicate payment options

Mail a check ($350 for pills, add $50 for tincture)Venmo to @Angie-Hotz ($350 for pills, add $50 for tincture)Cash at pickup*Print comes automatically with all packages
Mail Check to:

Angie Hotz

P.O. Box 98

Mount Vernon WA 98273
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Placenta Encapsulation Contract Form