Booking – The Placenta Pill

Encapsulation Booking
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Client Name (required)

Client Phone (required)

Client Email (required)

Due Date (required)

Partner Name (required)

Partner Phone (required)

Address (required)

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State (required)

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Birth Location (required)

Allergies / Notes

View our services!

Placenta Encapsulation - $300

Tincture - $100 Learn more here

Gold-Dipped Cord - $10 Learn more here

Terms and Conditions

I, , have asked The Placenta Pill, LLC and its employees to prepare my placenta in capsule form for my own personal use. As a condition of this service, I make the following assertions:

I understand that no guarantee of results is either offered or implied.

I release The Placenta Pill LLC from any and all liability resulting from the consumption of my placenta.

I understand that Placenta Pill LLC. does not diagnose or treat illness.

I understand that general guidelines for placenta capsule usage are provided for reference only and I trust in my own ability to follow my body for actual usage decisions.

Equipment failure is beyond the control of The Placenta Pill LLC and I understand that power loss or equipment failure may render my placenta unusable.

My placenta does not contain any transmittable diseases, such as, but not limited to; Hepatitis A, B or C, HIV/AIDS, STDs, MRSA, etc.

The placenta has been and/or will be handled in a manner appropriate for safe food preparation since the birth.

Once The Placenta Pill LLC employees have taken possession of my placenta, no refunds will be issued for any reason (other than encapsulation equipment power failure).

Warranty Disclaimer. The Placenta Pill LLC makes no representation, guaranty, or warranty, express or implied, in particular, the Placenta Pill LLC makes no representation, guarantee or warranty, express or implied, concerning the quality of the placenta for consumption or degree of personal results from the placenta, nor as to the merchantability or fitness for a particular purpose of products after processing by the Placenta Pill LLC.

I release The Placenta Pill LLC and its employees from any and all liability for any effects I may experience after choosing to take the placenta products. All terms must be checked to continue. You must sign to continue. If signed below, you are consenting to the use of an electronic signing method intending that the digital signature bears the same weight as a wet signature.

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Client Name:

Due Date:

Client Phone:

Client Email:

Partner Name:

Partner Phone:

Address:

Birth Location:

List of Services

Placenta Encapsulation - $300.00

Placenta Tincture - $100.00

Gold-Dipped Cord - $10.00

Total to be charged: $ 410.00

Credit card to be charged

This is a sample reminder what happens when you click the finished button. Your card will be charged, etc.

Encapsulation Booking Fill out below to get started!