Placenta Encapsulation | Claire Davies Doula

Placenta Encapsulation Booking Form

There are many possible benefits of placenta encapsulation. I personally ingested mine after the birth of my son and noticed an increase in my energy levels and a more stable mood. I found them extremely beneficial but always encourage my clients (as I would you) to check in with intuition if this is something that is right for you, and your body.

Other possible benefits include a decrease in postpartum mood disorders, increased production of oxytocin, a decrease in stress hormones, restoration of iron levels following bleeding after birth, and increased milk supply.

If you are wanting your placenta encapsulated, please complete the form below and an invoice will be generated.

Any questions please feel free to contact me at claire@clairedavies.com.au

Placenta Encapsulation Booking Form

Name

Address

Mobile

Partners Name

Partners Mobile

Estimated due date

Birthing Location

What method of encapsulation?

Raw $250

TCM $290 (pre steamed)

(Twins will be $50 more, please email Claire directly claire@clairedavies.com.au)

Would you like a cord keepsake?

Yes

Would you like a placenta print?

Yes

Placenta prints are $20

Delivery Options:

Free - Drop off and pick up to Claire (Mandurah location)

$50 - Claire to pick up from hospital and drop (Mandurah, Rockingham, Fremantle and South of the river region)

$90 – Claire to pick up and drop off (North of the river, Bunbury)

Do you authorise Claire to use photos of your placenta for social media and educational purposes?

Yes

Added extras:

$20 – Homemade roast vege soup + fresh sourdough

$22 – Homemade Walnut Loaf

$15 – Bliss Balls

Terms and conditions: I understand that…. (please check all the boxes)

I am not buying my placenta but paying Claire Davies Doula to prepare my baby’s placenta and encapsulate it for my personal use.

that Claire Davies Doula is not considered a pharmacist, medical doctor or herbalist and placenta services and encapsulation is not meant to be a replacement for medical advice or care

I am not carrying any transmittable diseases such as HIV 1 +2, Hepatitis B,C, Syphillis or Herpes/HPV virus

The placenta capsules will be returned within 24-72 hours of Claire Davies receiving my placenta

I am aware that Claire Davies makes no guarantee of my personal results with consuming my encapsulated placenta

I am aware capsules should not be consumed during times of sickness, such as the common cold or flu, as well as mastitis as it could make my condition worst

I will not hold Claire Davies (trading as Claire Davies Doula) responsible for any ill effects I may experience after choosing to consume the encapsulated placenta and I release Claire Davies from any and all liability

Client responsibilities I understand that….

It is my responsibility to notify Claire Davies that I have birthed my baby on 0428089829 via phone or text (business hours only, 8am-9pm) so arrangements can be made for collection/drop off so preparation of my placenta can begin

It is my responsibility to discuss release of the placenta from the hospital

My placenta must be prepared for transport by being placed in a plastic bag and container or bucket provided by hospital and ensure that its kept cool with ice blocks or kept in a refrigerator. If it is going to be greater than 3 days before the placenta can be prepared, I understand I need to freeze the placenta. I understand if it is delivered frozen that preparation will take longer as the placenta needs to be gently defrosted

Fees and Refund Policy

I understand that full payment needs to be made for my placenta encapsulation to be booked in with Claire Davies

If you choose to terminate this agreement less than 2 weeks before your estimated due date, 50% of the total will be refunded

There will be no refund of payment once preparation of my placenta has begun or if I choose to not consume or take delivery of the capsules

I understand that if any refunds are required from Claire Davies, that payment will be made in 7-10 business days via direct deposit in which Claire Davies will arrange to get these details from me

Date

Placenta Encapsulation Booking Form

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