PLACENTA ENCAPSULATION AGREEMENT

NOVA Birth Partners, LLC //

Placenta Encapsulation Services

All of our Packages include:
= Placenta Processing
= Choice of Preparation Method: Simply Dehydrated or Steamed & Dehydrated
= Preparation will take place in our dedicated workspace.

Nationwide Shipping // $500
+ Placenta Capsules

**FLAT RATE Fee of $500 FOR NATIONWIDE CLIENTS includes processing of the placenta pills only.

By completing this form, you are hiring NOVA Birth Partners, LLC for Placenta Encapsulation Services.

1Encapsulation Options > 2Agreement > 3Payment
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Name Name First Last
Phone Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Special Instructions or Gate Code
Due Date or Baby's Birth Date Due Date or Baby's Birth Date / MM / DD YYYY
Name of partner or person who is authorized to contact us regarding your placenta. Name of partner or person who is authorized to contact us regarding your placenta. First Last
Partner / Contact Person's Phone Partner / Contact Person's Phone - ### - ### ####
Planned Place of Birth
Address of Place of Birth Address of Place of Birth
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Is this your first baby?

Is this your first baby? Yes No
Have you encapsulated in the past?

Have you encapsulated in the past? Yes No
Any health concerns during this pregnancy? Are you currently taking any prescription medications?

If no, please type "N/A"
Do you know your current GBS (Group B strep) status?

Do you know your current GBS (Group B strep) status? Yes, my GBS test was negative. Yes, my GBS test was positive. I have not yet been tested. I declined GBS testing. I am unsure.
Have you ever been diagnosed with any of the following bloodborne diseases?

Have you ever been diagnosed with any of the following bloodborne diseases? None Herpes Simplex Virus (HSV-1 or HSV-2) Hepatitis B or C (Most local hospitals won't release the placenta, please consult with your care provider.) Other (Please list below)
How did you hear about our placenta services? Did anyone refer you to us?

Please put N/A if not applicable.
Choice of Placenta Encapsulation Services (EXCLUDES NATIONWIDE SHIPPING RATES)

Choice of Placenta Encapsulation Services (EXCLUDES NATIONWIDE SHIPPING RATES) TWINS: Add $125 Provide the powder only for self-encapsulation // $400
National Placenta Encapsulation

National Placenta Encapsulation $500 Flat Rate for Nationwide Services Local to CentralMD/DC/NorthernVA (Depends on availability) Add $150 for Placenta Cubes Shipping Other
Simply Dehydrated Preparation Method //
Raw Foods Inspired Method of Preparation. Also called "High-Yield" or "RAW" Method. This is the most popular choice of our clients. This method skips the steaming process altogether and the placenta is sliced while still "raw" and dehydrated immediately. The placenta is dehydrated at a minimum of 160 degrees according to USDA safety recommendations for dehydrating meat. At this temperature, bacteria and active enzymes are destroyed. It is believed that essential hormones are retained and the iron content is made more bio-available using the Raw Method. This method yields a higher number of capsules than Traditional Chinese Method. Based on responses from clients' experiences, this method is the most balancing as it produces both emotionally balancing properties and increased energy. Some indications for choosing the Simply Dehydrated Preparation Method would be: long labor, postpartum hemorrhage or a history of it, desire to increase breast milk and energy immediately postpartum.

Steamed and Dehydrated Preparation Method //
This method is also known as the Traditional Method, Traditional Chinese Medicine Inspired Method, or TCM. It is the oldest known method and follows with the TCM principles and specific needs during the postpartum period. In TCM theory, the process of labor and birth leaves the mother with an open, empty space which is considered very cold or yin. One way to promote healing during this time is to add warm energy via heat, or yang. This method of preparation involves steaming the placenta gently with optional herbs and then dehydrating at a minimum of 160 degrees. If desired, we can add fresh and organic lemon, ginger and cayenne pepper, only if requested. Putting the herbs in the steaming process is thought to bring out the placenta’s natural healing properties. Lemon is thought of as an antiseptic and helps to distribute the placenta throughout the body. Cayenne and ginger are warming herbs and thought to lend their properties to the placenta. The ginger specifically acts as a facilitator for energy and good blood flow. TCM is believed to offer toning, healing and warming properties. If your placenta has been frozen, this is always the method of choice.
Choice of Encapsulation Method

Choice of Encapsulation Method Simply Dehydrated Method (Raw) Steamed + Dehydrated Method
Choice of Capsules

Choice of Capsules Clear Vegan Plain, Unflavored Gelatin Berry Flavored Gelatin (If available)
Twin Placenta Options ONLY
(for twins with 2 placentas)

Twin Placenta Options ONLY (for twins with 2 placentas) Process and bottle both placentas together; add $125 Process and bottle each placenta separately; add $150 fee
Additional Options to add on include:

Additional Options to add on include: Placenta Prints $75 Tincture (4 oz) $50 Healing Salve (2 oz) $60 Postpartum Herbal Bath (3 oz) $25 Placenta Cubes (Add-on to pills) $200 Other
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PLACENTA ENCAPSULATION AGREEMENT

PLACENTA ENCAPSULATION AGREEMENT

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