Placenta Encapsulation Services Agreement

Placenta Encapsulation Services Agreement

I ___________________________, have asked       Amanda Hartman         to prepare
             Printed Client Name              Placenta Encapsulation Specialist (PES)

my baby’s placenta in capsule form for my own personal use. 

As a condition of this service, I make the following assertions:

I agree that…
I am paying for the encapsulation service only.
My placenta does not contain any transmittable diseases such as Hepatitis-B, -C or HIV/AIDS.
My care provider and I have determined that my placenta is healthy and suitable for encapsulation.
The placenta has been handled in a manner appropriate for safe food preparation since the birth. 

I understand that:

The PES views each placenta as a sacred connection between mother and child and will treat it 
accordingly. I will not hold the PES responsible if my placenta is accidentally damaged during the encapsulation process.
The PES does not determine whether my placenta should be consumed and makes no guarantee of my personal results from the capsules.
I understand that all preparations of my placenta will happen in the house of the PES, which is a sterile environment for my placenta.
The capsules should not be taken during times of illness, such as the common cold, flu, or mastitis. I understand that taking the capsules can make these conditions worsen. 
The PES uses the Raw Dehydration Method.  This method involves slicing the placenta while fresh and raw, dehydrating it immediately.  It is widely held that the hormones are more likely to be bioavailable when the placenta is processed raw.

Limitations and Disclaimer:

The is not a pharmacy, pharmaceutical representative, holistic practitioner, herbalist, or medical doctor and cannot diagnose, treat, or prescribe for any health condition.  Services and fees are for the preparation and encapsulation of the placenta, not for the sale of the pills.  No specific benefits or effects are promised.  Individual results may vary.  The benefits of placenta consumption are supported by ongoing research, but have not been evaluated or approved by the FDA.  It is your responsibility to determine if placenta preparation and consumption may be of benefit to you.

Client Responsibility:

It is your responsibility to notify me as soon as possible after the birth to make arrangements for transfer of your placenta.  Failure to do so may result in delayed placenta preparation and encapsulation, and can cause decreased potency of nutrients, hormones, and other beneficial attributes of the placenta.  Improperly handled placentas are susceptible to spoilage and all placenta work is done at your own risk.

It is your responsibility to discuss the release of your placenta with your primary health care provider as well as the facility you will be birthing in.  Please make sure your placenta is refrigerated or kept on ice until it can be picked up or delivered for preparation and encapsulation.

Your placenta may be kept at room temperature for 3 hours following your birth.  After that, it should be placed on ice or in a refrigerator.  If it is going to be 3 or more days before your placenta can be processed, it should be frozen.  A frozen placenta will require 2 additional days for processing, since it must be gently defrosted prior to being dehydrated.

I release Amanda Hartman and the PES (if other) from any and all liability for any 
effects I may experience after choosing to take the capsules.

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