Hudson Valley Placenta Services Registration
Thank you for choosing Hudson Valley Placenta Services! HVPS was the first to offer professional placenta services in the Hudson Valley region and continues to offer the same high quality services that have satisfied many new families since 2009.

Please complete this form and make the non-refundable deposit of $65.  Price of the service includes pick up (see below for cost by location) and USPS shipment costs for return (delivery will happen on a case by case basis dependent upon location), or pick up at Waddle n Swaddle.  Please initial where indicated and type your name & the date at the end, as an electronic signature. HVPS respects your right to privacy and assures you that all answers are held in strictest confidence. The handling instructions are also included in the Transport Kit which will be mailed or can be picked up at Waddle n Swaddle upon receipt of your deposit.  

The non refundable deposit of $65 is due within 2 days of registration and can be paid via 
Venmo jennifer-sullivan-131
Zelle 845-240-8399
PayPal jenn@jennsullivan.com

We look forward to serving you and your family!

Questions?  Text Jenn @ 845-240-8399
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Email *
First and Last name *
Full Home Address (Street, City, State & Zip Code) *
USPS Delivery Address (if different from above)
Estimated Due Date *
MM
/
DD
/
YYYY
Primary E-Mail Address *
Cell Phone Number *
Secondary Number
Have you had any of the following during this pregnancy (please check all that apply even if you have been treated, make a note in the "Other" Category if you have a history of the following or any that are not listed) *
Required
Where will you be delivering? *
Required
Placenta Pills *
The non-refundable deposit of $65 must be received within 48hrs of registration to hold your spot on calendar. Limited spots are available. Once received, I will mail kit or let you know it’s ready at Waddle n Swaddle for pick up. 

It can be paid via 
Venmo jennifer-sullivan-131
Zelle 845-240-8399
PayPal jenn@jennsullivan.com
 *
Required
A copy of your responses will be emailed to the address you provided.
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