Get Started

Thank you for choosing Palouse Placenta for your encapsulation!

Complete this form to hire Palouse Placenta to encapsulate your placenta. At the end of the form you can pay the $50 deposit here; this deposit will be applied to your encapsulation fee. If you cannot make an electronic payment please contact us to discuss other payment methods.


Personal Information
Health
Known Conditions
Expecting
Preferences
The method that I would like my placenta prepared:
Capsule preference:
Additional placenta services I would like (+25/e, 40/2):
The ink I prefer to be used for my print is
RESPONSIBILITIES
I agree to the following:
DISCLAIMER
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FEES
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STATEMENT OF POLICY
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Photo Release
I take photos of your placenta for record keeping purposes. These photos are available to you at any time. With your permission I may use these photos for marketing, advertising, education, peer review or promotional purposes in print or online. Identifying information will not be shared under any circumstances. Do you give permission for photos of your placenta to be used as described here?