Placenta Services Letter of Agreement
Please be aware that this Letter of Agreement does not replace or negate an in-person, email, or telephone consult to discuss process, a brief medical & pregnancy history, and your individual wants and needs around the encapsulation process.
Please ensure that we have communicated either by phone or email and that I am available to serve you prior to filling out any forms or submitting a deposit.
Please read carefully, sign and submit the form below, along with the Intake Form. Both forms are necessary for services.
Deposit Button is located below, above form. Contact me with any questions or concerns.
Placenta encapsulation is the act of taking a fresh, raw placenta, washing the placenta, steaming or slicing the placenta raw, dehydrating, grinding, and then placing the placenta powder into consumable capsules. All processes are done with respect and education of that placenta and in a sanitary environment. My business is adhering to strict OSHA guidelines and I am following proper food safety standards. The placenta capsules that are being prepared are for the owner of the placenta only. The placenta capsules are not designed to reverse medical conditions or ailments caused by pregnancy, to treat postpartum depression, to ensure normal milk supply or to replace medical attention.
As your encapsulation specialist, I am not a licensed medical professional such as a care provider or physician. I am not able to diagnose, treat, or prescribe for any medical or health condition. Services and fees are for the service of encapsulating your placenta, not the sale of the capsules. Each woman will react to her placenta capsules differently. Some of the ascribed benefits of placenta consumption are supported by ongoing research, however, these benefits have not been evaluated or approved by the United States government or the Food and Drug Administration. It is your responsibility to determine whether using placenta capsules can be beneficial to your personal wellbeing during the postpartum period.
It is your responsibility to notify me within 4 (four) hours of the birth barring any emergencies so that we may work together to make arrangements for pickup or, if applicable, drop off. 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. Improper storage of the placenta prior to it coming into my possession may result in spoilage. This includes the placenta being held in pathology. It is your responsibility to discuss release of your placenta from the facility where you will give birth during the prenatal period and to ensure proper storage of your placenta in a refrigerator or cooler. This can be done by placing the placenta on ice until it can be retrieved for preparation and encapsulation. The facility staff should be aware of your needs and can assist you in proper storage. Placentas stored for longer than 3 days without being frozen will no longer be eligible for encapsulation.
It is also your responsibility to inform me of any known blood-borne illness(es) or other health issues (such as HIV, Hepatitis, etc.) that could place me or any others who may come into contact with your bodily fluids (specifically maternal and fetal blood as well as amniotic fluid) at risk. GBS+ does not preclude you from encapsulation, however it is your responsibility to inform me and I will prepare your placenta accordingly to ensure all bacteria is eliminated.
My responsibilities include maintaining client confidentiality, committing to preparing and returning your capsules within 72 hours of receiving your placenta (usually within 24-48 hours) and upholding the highest standards of cleanliness, safety, and quality of professional placenta preparation services. In the event that I am unable to be available for your placenta encapsulation, I will provide a backup placenta specialist who is capable of providing services.
It is important to understand that there may be circumstances in which your placenta cannot be used. Significant abnormalities of the placenta may necessitate your doctor or midwife sending your placenta to Pathology for further examination. Once the placenta has been released to Pathology, I will not be able to encapsulate without an additional waiver, if at all, as there is a significant risk for spoilage, loss, mixup, and cross contamination with chemicals or bodily fluids. Other conditions, such as signs of infection in the mother during labor, may mean that consuming your placenta could be harmful to your health. If your facility or care provider wants to examine or hold placental tissue, please encourage them to take a small piece and leave the rest in your possession. I will always consult with you prior to making a choice on whether or not your placenta is viable for ingestion. It should be possible to claim your placenta after caesarean surgery. It is important that you let me know if you have any health concerns or conditions which may affect the health of your placenta or the health and safety of anyone who may come into contact with your placenta.
Package fees are as follows. You agree to pay the specified amount assigned to the products or packages you choose.
- Basic Package $250.00
- Deluxe Package $300.00
- Ultimate Package $400.00
In the event your placenta is unavailable to you (ex. sent to Pathology and not released despite coordination efforts) or if your placenta has been contaminated with a bacterial infection, you will be entitled to a refund in the amount of $25.00, half of the deposit fee. If you choose to terminate this contract due to change of mind within 7 days of your estimated delivery date, then you are no longer eligible for a full refund. If I have already taken possession of your placenta and you choose to not go forward with services, I will return your placenta to you for disposal. There will be no refund.
I understand and acknowledge that in accordance to my state laws and bylaws, choosing to encapsulate my placenta is not intended to prevent or treat any physical or mental diseases, ailments or symptoms and that I am choosing to consume my placenta for my own personal beliefs, whether it be spiritual or cultural.
I acknowledge that my placenta specialist has provided me with concrete information about both the benefits and risks of placenta encapsulation, and have read all included documents. I understand that my placenta has been handled and encapsulated according to OSHA and State Food Safety and Handling standards, and has been cleaned, cooked, dehydrated and put into pill form in a sanitary and sterile work space. Upon receiving my placenta capsules from my placenta specialist, I waive any and all rights to hold the specialist responsible for any undesired effect of consuming the capsules. This may include an oversupply in milk, hormonal shift, anxiety or sleeplessness. These side effects are rare, but have been reported. I agree to contact my placenta specialist immediately if and when I experience any of these side effects.
My specialist agrees to complete (2) postpartum follow-up check in's up until (2) weeks postpartum, either by phone, email, or in person. An additional follow up at 6 weeks is available if desired. My specialist agrees to be available by phone or email as long as I have capsules in my possession to answer questions and concerns. I do not hold my placenta specialist responsible or liable for any transport mishap that is beyond their control (ex. car accident or detainment).
If my placenta is not encapsulated in my own home, I put full trust and acknowledgement that it is being handled in a sanitary and safe environment. I put trust and faith that my placenta specialist has been training correctly to prepare placenta remedies. I have provided my placenta specialist with recent blood documentation stating that I have been tested for STD’s and the results were negative. If my blood results indicate hepatitis, HIV/AIDS or Herpes virus, I understand that I will allow my placenta specialist to prepare in my home, using some of my own supplies. Universal precautions for sanitizing are the same with each client. I understand and trust that my placenta specialist retains blood work records for each client and that I am protected.
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.
I have read, understood, and agreed to the above information. I accept the responsibility of gaining possession of my placenta, and notifying my placenta specialist within 4 hours of my birth. I understand the importance of appropriate handling and storage of the placenta. By signing below I authorize the release of my healthy placenta to Jennifer Lynn Frye for the purposes of placenta encapsulation and keepsake preparation for my own personal use.
A $50.00 deposit will ensure that I have availability and that I will be in town one week before & one week after your EDD. Balance is due upon delivery of capsules. Additional services are available for an extra fee. Deposits can be made electronically via paypal, check, or cash.
LETTER OF AGREEMENT
IF YOU ARE CHOOSING TO HIRE ME AS YOUR PLACENTA ENCAPSULATION SPECIALIST, PLEASE FILL OUT THE FORM BELOW & SUBMIT, ALONG WITH ADDITIONAL INTAKE FORM (LINK AVAILABLE ABOVE AND BELOW).
IF DESIRED, I WILL EMAIL YOU A COPY OF THE CONTRACT TO KEEP FOR YOUR RECORDS.
Please click here to fill out the Intake Form if you haven't already! Thank you!