If you are planning a hospital or birth center birth, please indicate which one. 

(Only if you choose to have your partner speak on your behalf for your placenta preparation)

Placenta preparation, as offered by Moon Garden Midwifery, is not clinical, pharmaceutical, or intended to diagnose or treat any condition. Placenta preparation is not meant to be a replacement for medical advice, medical care or medicine. Services and fees are for the preparation and encapsulation of your placenta and not for the sale of the capsules. Families that choose to utilize placenta preparation services take full responsibility for their own health and for researching and using placenta for ingestion. Moon Garden Midwifery does not make any guarantee as to the efficacy of placentophgy but does guarantee the highest quality of service. Benefits of placentophagy are supported by ongoing research but have not been evaluated by the FDA. (Please initial below)

Whether birthing at home or in a hospital, please ensure that your placenta is kept fresh. It can remain at room temperature for about 4 hours following the birth. After that it should be refrigerated or otherwise kept cool (40 degrees °F or less). If you are practicing some form of delayed cord cutting beyond the 3-4 hour window or lotus birth, please contact Moon Garden Midwifery to discuss further. If it is going to be more than 72 hours before the placenta can be prepared, it should be frozen. (A frozen placenta will take somewhat longer to prepare since it will need to gently defrost it prior to preparation.) You can prepare your placenta for transport by placing it in two large (gallon size), freezer strength zip-lock bags, then into a cooler or large covered bowl or bucket with ice/ice packs or into a refrigerator. ~~~ It is important to note that there may be circumstances under which your placenta can not be used. Significant abnormalities of the placenta may necessitate your doctor or midwife sending your placenta to pathology for further examination. Other conditions, such as signs of infection in the mother during labor, may mean that consuming your placenta will not be beneficial to you. Please inform us if you have developed an infection during labor or if your baby has been diagnosed with an infection shortly after birth.  

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It is your responsibility to notify Moon Garden Midwifery after the birth (ideally within 24 hours) to make arrangements for pick up, drop off, or for services to begin in your home. Failure to do so may result in delayed placenta preparation and encapsulation and may cause spoilage of the placenta which would render it unusable for encapsulation. ~~~ It is your responsibility to discuss release of your placenta from the hospital where you give birth and to ensure proper labeling and storage of your placenta in a refrigerator or cooler with the placenta placed on ice until it can be picked up or delivered for preparation and encapsulation. Your placenta should not be treated with alcohol, formalin, or any other preservative.(Please initial.)

Fees for the encapsulation preparation are $300 and are to be paid at the initiation of service. 

Placenta Smoothie prep (without encapsulation prep) $125

Placenta prints only (without encapsulation preparation) are $125.

Placenta Tincture without encapsulation is $50

Lotus birth preparation $300

A travel fee of $50 for services in excess of 25 miles from Phoenix, 85085 may apply. Cash/Check/Credit/Debit/Zelle, are accepted.  Alternative payment plans available upon request. There is a fee of $35 for returned checks. All fees are non refundable. Please initial below

Check the services that you want  

I have read, understood, and agreed to the above procedures, information, and statements of policy. By typing my name below, as an electronic signature, I give my consent to release my healthy placenta to a representative of Moon Garden Midwifery for the purposes of encapsulation or other placenta preparation services. I accept the responsibility of gaining possession of the placenta after the birth, handling of the placenta appropriately prior to Moon Garden Midwifery taking possession of it, and notifying Moon Garden Midwifery of my birth within 24 hours.  I authorize the release of my placenta to Moon Garden Midwifery and I authorize Moon Garden Midwifery to transport my placenta for preparation if necessary. 

Please type your name, as your electronic signature, to show that you have read all of the above information and that all of the above information submitted by your is true and accurate.