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Mom's Name *
Mom's Name
Phone *
Phone
Estimated Due Date *
Estimated Due Date
Contact Person's Name *
Contact Person's Name
Contact Person's Phone Number *
Contact Person's Phone Number
Placenta Encapsulation $300 *
Method of encapsulation
Salve $100 *
Agreement
I understand that Candy Ramirez and Bearing Heart are not licensed medical providers and that the FDA has not evaluated these services. The services offered are not clinical, pharmaceutical, or intended to diagnose or treat any condition. The fee Iā€™m paying is for the preparation and encapsulation of the placenta and not for the placenta pills. Families who choose to utilize these services take full responsibility for their own health and for researching and using capsules. I understand that all handling of the placenta is done in a disinfected environment.