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Placenta Encapsulation Booking Form
Thanks for choosing me to encapsulate your placenta!
Please fill in the details below and I will email you an invoice and contract within 24 hours.
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Preparation Methods
*
Placenta Capsules Steamed Method
Placenta Capsules Raw Method
Placenta Chocolates
Half capsules Half Chocolates
Placenta Smoothies (30)
Half Capsules / Half Smoothies
Placenta Powder
Tree of Life Package
Required
Your Name
Your answer
Estimated Due Date
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/
DD
/
YYYY
Phone Number
Your answer
Address
Your answer
Email
Your answer
Planned Birth Location
Your answer
I understand that Kate Porter is not responsible for cases in which the placenta is unable to be process, such as due to infection in labor or other abnormalities
Yes
No
Clear selection
I understand that I am responsible for communicating with my provider that I intend to keep my placenta, and communicating with Kate to arrange for pickup of my placenta from my birth location or my home.
Yes
No
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