THE LANGUAGE OF BIRTH: Placenta Order Form

A few important notes:
01.) Encapsulation is usually complete within 2-4 days of pickup. Tinctures take 6 weeks.

02.) Payment is due upon placenta pickup. I accept cash, checks, and Venmo.
Checks can be made out to Stepha Lawson
Venmo is: @thelanguageofbirth

03.) When baby has arrived, keep the placenta in the refrigerator until pick up. Placentas keep well in the fridge for up to three days. It is my standard to pick up your placenta within 24 hours of your call.
CALL or TEXT 425.283.6122 to let me know you are ready for pick up

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FULL NAME *
PHONE NUMBER *
EMAIL ADDRESS *
Which City Do You Reside In? (Areas with delivery fees have the option of delivery or a $10 mailing fee for finished placenta) *
HOME ADDRESS *
EDD or date of request if after birth *
MM
/
DD
/
YYYY
PLACENTA PROCESS METHOD *
Required
WOULD YOU LIKE PLACENTA PRINTS? *
Do you have any allergies? *
This helps me eliminate anything that could cause a reaction
Required
Any considerations about the health of the placenta? *
I have prepared placentas from home, birth center and hospital births including births using pitocin, epidurals, and c-sections. Meconium and/or poop are not a problem, giving the placenta a quick rinse usually helps, and I will likely cut away areas that are too heavily stained.
Required
Any considerations about the health of the mother? *
Because I am working with an organ and blood, I must take precautions to ensure my safety and the safety of the birthing mother/person. Please disclose any communicable diseases. Responses are kept confidential.
Required
Referral Source, how did you hear about me? *
I like to know how you heard about me, it helps to know where my clients come from
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