Full Name
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First Name
Last Name
Email
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Phone
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Home address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Birth support name
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This will be the person I will contact to liase pick up & delivery when you are not available or who you have nominated to liase with me.
First Name
Last Name
Birth support contact details
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This can be anyone who will be present at your birth, whom you are happy to liaise with me if required.
Country
(###)
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Intended place of birth
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If you are birthing at Gold Coast University , Gold Coast Private or John Flynn. You will incur a $20 fee for parking
Estimated due date
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Please note, I am on leave from July 31st - August 17. You can still have your placenta encapsulated by me but if you birth during this period, I will give you instructions on how to freeze your placenta. Your placenta will then be dropped off to me or collected to begin processing upon my return.
MM
DD
YYYY
Do you know the sex of your baby?
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Planned C section, planned induction or natural
Planned C section
Planned Induction
Natural
Have you tested positive to Heptitis, HIV or Aids
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Have you tested positive to Heptitis, HIV or Aids
Have you tested positive to Group B Strep?
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Yes
No
Do you understand that if you test GBS positive, have large amounts of meconium present I will need to make the decision to encapsulate in the TCM method as steaming will kill off further bacterias if present.
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Have you done your own research into placenta encapsulation?
Have you had your Placenta Encapsulated before?
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Do you smoke or have in the last 12 months?
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Please select your package
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Raw Placenta encapsulation package $325
TCM Placenta encapsulation package $350
Placenta Dust package $150
Capsules only $270 RAW
Capsules only $285 TCM
Placenta Canvas print $40
Half TCM - Half Raw $355
Return to earth package $290 Raw
Return to earth package $320 TCM
Ultimate Complete Placenta Package TCM $525 (saving of $15)
Ultimate Complete Placenta Package Raw $505 (savings of $15)
Capsule flavours
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Discount code:
Pick Up & Delivery Required
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Delivery & Pick-up fees:
GOLD COAST FREE within 15kms of Nerang.
Gold Coast University incurs a $20 fee, this covers parking.
Outside of 15km of Nerang on the Gold Coast a flat fee of $55 to collect & redeliver your package.
Tweed Valley Hospital flat fee $70 - inc of pick up & drop off.
Outside of Gold Coast please enquire.
* Brisbane
* Tweed Heads & surrounds
* Northern Rivers
* Byron Bay
* Murwillumbah
* Ocean Shores
To avoid fees, you have the option to drop off and pick up from Nerang lab location.
Would you like to hire my placenta storage box for $20 fee? This will need to be collected from Nerang before 38 weeks gestation.
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Incudes:
- Foam box (labeled)
- 1.2L white medical grade placenta bucket.
- x2 freezer bags
- x3 gel icepacks (dry ice packs coming soon)
Would you like a Cord keepsake? This is a FREE optional selection.
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How would you like to receive your cord keepsake? Please refer to my IG page for visuals ( @motherorganic_)
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Painted in the following or kept natural.
Would you like 3 raw images of your placenta? This will sent via email/ text or Whatsapp. Please note there may be blood present.
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Would you like to upgrade to a canvas Placenta art print? ($40.00 fee)
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YES
NO
Add on -Placenta tincture 200ml bottle + 60ml droppper bottle $75
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This will be given to you after 6 weeks of steeping. Either free pick up from Nerang or postage.
Add on - Placenta balm (salve) 120ml Jar $65
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Delivered with your package
Do you have any allergies?
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If so what, please list below.
Do you have any questions? or more information to provide me with
Do you understand that if a birth takes place through the night I will only be able to collect your placenta first thing the following morning?
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If you are birthing at GCUH - Please be aware they do not store patient's placentas & bringing your own Ice packs are recommended (to be advised further) - Storage may be provided to you by the hospital (white sealed container).
Do you understand it will be your responsibility to ensure the placenta is stored correctly with either ice or icepacks as directed by me. If not your placenta will not be able to be encapsulated. In this case your deposit will not be refunded.
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Do you understand in case of emergency, I will intruct you what to do. This will mean either storing in your fridge or storing in your freezer until a pick up or delivery is able to be made.
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Do you understand Full payment must be made prior to delivery of your package.
Do you understand if the placenta is frozen it will take an additional 24 hours to process your package
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This is due to the natural thawing out process
I understand any location outside of 15km of Nerang with incur a total of $55 travel fee - this is for pick up & drop off.
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Terms & Conditions
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By selecting this box you acknowledge you have read and accept our Terms & Conditions..
I understand that once I have recieved my booking invoice a $100 deposit will be paid within 48hrs of receiving it
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Once a invoice has been sent out, to lock in your spot/ service you must pay a deposit of $100 within 48hrs of it being sent out. Spots fill very quickly ahead of time. Should you have any issues please feel free to have a chat with me.
I agree to have anonymous photos of my placenta used on social media.
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Last minute decision to encapsulate is welcomed. Please ensure your placenta is refridgerated, put into a clean container and placed into a esky surrounded in ice or icepacks or put into the freezer (double bagged in freezer bags) within 1-2 hours post birth. Please also text me using the contact details provided. You will be responsible for the storage of your placenta prior to getting it to me.
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Last minute packages must be paid prior to package delivery
What is your IG handle? (I would love to follow your journey of motherhood & recieve any tags if you feel called to share.
First Name
Last Name
Where did you hear about Mother Organic
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