Consent & Agreement for Placenta Encapsulation

“You”, “your” refers to client.  “I”, “me”, “we”, “our” refers to Karen Herriot and Angie Evans.

Service Provided:

• Karen, Angie & their colleagues (used periodically for back-up, to ensure safe and timely service in the rare case that we’re both out of town) are Certified Placenta Encapsulation Specialists.  That means we all process placentas in the same manner, using high quality and properly sterilized equipment.
• We provide the service of turning your own placenta into capsules for your own use only.
• All methods of encapsulation are practiced using OSHA standards and are subject to strict hygiene standards, and to the best of our awareness of Environmental Health.
• Details are covered on our Placenta Services page and in the Placenta Capsules FAQs.
• Your personal information is confidential and only shared between ourselves.
• Processing usually takes 1-3 days from the time of pick-up.

Client Obligations:

• Please ensure you have our cell numbers in your phone (306) 216-8116.
• Print Birth Bag Note and keep it with your birth bag – it has all the details you’ll need (can also be accessed online).
• Have a container in your birth-supplies, to be used as a back-up in case your birth attendants don’t provide one.  Instructions are in the Birth Bag Note.
• If possible, please text when you go into labour to give a ‘heads up’ (only during awake hours: 8am-9pm).
• Inform your birth attendants / hospital staff that you plan to keep your placenta (verbally or in Birth Plan).
• Text to let us know placenta is born, between 8am – 9pm.  If birth occurs overnight, between 9pm – 8am then keep placenta chilled as outlined in Birth Bag Note.
• If payment isn’t arranged ahead of time, then please provide cash or e-transfer when placenta is picked up.  Fees are outlined below.
• Please complete this online Consent Form / agreement.

Fees are due before we start the processing of your placenta. Please check the appropriate boxes.  We accept the following payment methods:

• Cash with placenta.
• Cheque (dated 2 weeks before your due-date) and received by 37 weeks. Please ask us for the name and address to use.
• E-transfer to EncapsulationRegina@gmail.com, either ahead of time or when you notify us to pick up your placenta. We deposit the e-trans when we pick up the placenta or just the e-transfer expires, which-ever comes first. Please choose an easy password such as “placenta”.

Cancellation policy: If you cancel at anytime before we pick up your placenta, then all fees are waived.  If you prepaid then all placenta encapsulation fees are returned.  All fees are payable once the placenta has been picked up.

Risks: There are general risks with consuming your placenta, as with ingesting any meats. It’s possible that pathogens (bacteria, virus) can be present if the placenta is not processed according to strict guidelines (which we follow, outlined in our FAQs) or is not kept cool (per instructions in Birth Bag Note) before processing.

Distance Processing (for out-of-town clients):  If you give birth in Regina we’ll pick up your placenta. For out of town birth, please package and send the placenta as outlined in the Birth Bag Note. You are responsible for packaging, logistics and cost of shipping the placenta to us in Regina. If we’re shipping the capsules to you, then please add an additional $25 to cover return shipping, as outlined in the fees. There is no extra fee if you arrange for delivery from Regina to you (e.g. friend, family) or put it on your own courier account.

You have read the above information. You consent to having your placenta handled and processed by Karen Herriot, Angie Evans and/or one of their carefully selected back-up encapsulators. You agree that the aforementioned are not liable and do not take responsibility for any results or effects you may experience before, during or after the placenta encapsulation. You understand that the placenta encapsulators are providing the service of turning your own placenta into capsules for your use only. The encapsulators are not selling products, and are not diagnosing or prescribing with this service.

Privacy: Your information stays with us and is only used for us to contact you.  We are vaults of privacy!  That comes with this line of work.