Placenta Encapsulation Service Agreement
Collectively, all of the people or businesses entering this Agreement will be referred to as the "Clients."
Purpose of the Agreement: Client wishes to hire Provider to provide services relating to Client’s Placenta Encapsulation as detailed in this Agreement. Provider has agreed to provide such services according to the terms of this Agreement.
Correo electrónico *
First and Last Name *
Phone number *
Client's Residential Address *
Birthing Facility Name & Address *
Expected Due Date (EDD) *
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Check all that apply— Have you experienced any of the following complications? Steaming method is highly recommended with any of these complications present. Please discuss with Bethany any details and concerns about your complication. *
Obligatoria
What encapsulation method do you prefer? *
What capsule would you like? *
What keepsake would you like? *
What is your venmo or cashapp username? ($100 non-refundable retainer) *
PROMO DISCOUNT CODE:
NATIONWIDE SHIPPING AVAILABLE: I understand the total for placenta encapsulation + shipping starts at $400. I understand once I sign this contract and place the deposit, a cooler will be shipped to me with further instructions.
I understand the deposit of $100 will be billed to my cashapp or venmo once this contract is signed. The deposit must be paid no later than a week after signing this contract to ensure all potential clientʻs can fill the limited availability. The remaining amount will be billed the day of placenta pick-up or processing cannot begin.
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Obligatoria
I understand if I have any questions or concerns about the process or need help advocating for my placenta to contact Bethany via text/ call/ voicemail at 559-365-6659. *
Obligatoria
I understand placenta encapsulation is a 48-hour process with a 5 business day turn-around time (excluding transportation time). *
Obligatoria
I understand that the $100 deposit is non-refundable (no exceptions). If you are in a predicament where the staff refuses to release your placenta contact Bethany via email or phone. At a minimum, Client agrees that the retainer fee fairly compensates Provider for committing to provide the Services and turning down other potential projects/clients. *
Obligatoria
I understand an additional $50 travel fee is applied for clientʻs residing outside of Fresno/ Clovis (does not apply to nationwide shipping). I also understand there are options to waive the travel fee in which itʻs my responsibility to consult with Bethany. *
Obligatoria
I understand that especially in the case of a caesarean birth, the placenta is not allowed to go through chemical testing (pathology) or the placenta will not be safe to consume. In this event or any event where the medical staff is resistant to handing you your placenta, please call Bethany for advocation assistance.
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Obligatoria
I understand my placenta will be picked up within 24 hours of my birth (no overnight pickups); unless Bethany is out of town or has an emergency. In that event, the client will freeze their placenta within 48 hours, until Bethany is back in town in which pick-up and processing will proceed.
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Obligatoria
I understand that if I've ever been diagnosed with or afflicted with any of the following diseases, it's advised against to encapsulate or consume my placenta: ● HIV/AIDS ● OTHER STI's  ● Hepatitis A, B, C ● Ebola ● Chorioamnionitis (infection of the placenta; usually related with a laboring fever) *Note: For your safety and the safety of others, if you have ever had any of the above mentioned bloodborne diseases, Provider will be unable to process your placenta.
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Obligatoria
I understand to notify Provider when I am in labor and again as soon as possible after birth to make arrangements for transfer of the placenta. Improperly handled placentas are susceptible to spoilage and all placenta work is done at own your risk. I understand that the act of ingesting placenta in any form has not been tested, nor approved by the FDA, and I ingest this at my own risk. Furthermore, I release Bethany Birth Services (Bethany Chavez) and its representatives from any liability.
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Obligatoria
I understand to discuss the waiver of the placenta with my health care provider as well as the birthing facility. The placenta must be put on ice no later than 2-3 hours after birth and kept on fresh ice or in a refrigerator up to 48 hours. After 48 hours, itʻs advised to freeze the placenta until pick-up in which the Provider of Bethany Birth Services will provide a cooler and cooling for transport.
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Obligatoria
I understand that Provider is not a medical professional, is 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 benefits are well supported by evidence based research; but none have been evaluated or approved by the FDA.
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Obligatoria
I understand that by signing this contract, I give Bethany Birth Services permission to post educational photos and videos about my placenta via social media (no confidential information will be revealed).
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Obligatoria
Provide e-signature below to agree to all terms listed above including those online FAQs https://bethanybirth.squarespace.com/blog/frequently-asked-questions-about-placenta-encapsulation  *
Se enviará un correo electrónico con una copia de tus respuestas a la dirección que suministraste.
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