Placenta Encapsulation Registration

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Gentle Woman Birth Services provides women with APPA Certified (Association of Placenta Preparation Arts) Placenta Specialists. APPA is the safest and most knowledgeable certification organization not only in the US, but worldwide. All specialists are triple certified, meaning they are certified with the State of Louisiana, certified in Blood Borne Pathogens, and APPA certified *yearly* in order to be the most up-to-date specialists on the latest scientific information in our field. Our specialists proudly serve the Acadiana area! If you are outside of this area, please feel free to call 337-591-5781 to get contact information regarding a specialist close to you.

Once you are registered here, an invoice will be emailed or texted to you. Then you will need to pay a deposit of $25 to hold your spot and pay for your transportation kit, which will be mailed to you at 36 weeks (unless otherwise specified by you). Be sure to **print out** our contract (the link is in the last box), sign, and place in your transportation kit before you go to your place of birth.

Mother's Name *

Estimated Due Date *

YYYY

Cell phone number *

Spouse/Partner's Name

Partner's or Secondary mobile number *

Mother's Email Address *

Mother's Physical Address *

Name of Obstetrician or Midwife

Place of Birth (home, hospital, birth center)

I am registering for the following service(s): *

Basic Package: Placenta Encapsulation (Traditional OR Raw preparation - includes capsules, info booklet, cord keepsake) $225

Placenta Tincture (4oz bottle of placenta that prolongs the benefits of your capsules) $40

Placenta Print (artist-grade quality print of your placenta) $20.

Digital Prints (this is an add-on to the artist grade print!) $10

Smoothie Prep (14 raw, individualy wrapped pieces that are frozen and ready for smoothies) $45

Half & Half Encapsulation (Not sure which method you prefer? Then do half raw prep, half traditional prep! Each bottled seperately) $60

Salve (great for stretch marks and scars!)

Required

How did you hear about us?

Please print our full contract and sign. Then place the contract in one of the pockets of your placenta kit and bring to your birth place with you. Type "yes" in the blank below to confirm you printed the form. https://www.dropbox.com/s/hwx60m7hk0nojii/Encapsulation%20Service%20Agreement%20%281%29.pdf?dl=0 *

Coupon Code if applicable

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