Name *

First Name

Last Name

Phone

(###)

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Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Services Requested *

Placenta Encapsulation // $325 ***Note that this option required a drop off and pick up of your capsules in SF

I prefer Maliya organizes a pick up AND drop off at my home, once my capsules arecompleted // $375

Cord Keepsake // complimentary

Twin placenta(s) // additional $50

Placenta Print // $20

Placenta Tincture (6 wk. process) // $50

Sitz bath: herbs for after birth // $25

Postpartum Tea Blend // $20

Calendula+Cannabis Salve/ 1 oz jar/ $25

Placenta Agreement

I have read the Contract for Placenta Encapsulation Services (***linked above) and have asked the necessary questions, making all items stated herein clearly understood. I agree to the terms as stated.

I understand that full payment is due when the placenta is picked up by, or delivered to, Maliya. The encapsulation process will not begin without payment.

I understand that a maternal or fetal infection at or immediately following the time of delivery is a contraindication to encapsulation. An allergic reaction to meds received during labor is also a contraindication. It is unsafe to encapsulate in these cases.