You can always press Enter⏎ to continue

Product Order Form

A simple order form template with quantity, color and size options. Ideal for preparing an order form in seconds.
  • 1
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    Please click which hospital AND POSTAGE if you would like express post return and fees will be adjust once the form is submitted.
    Press
    Enter
  • 8
    Multiple choice, (would you like the free cord keepsake?)
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    Best to have it on your file on on your birth plan
    Press
    Enter
  • 11
    If so encapsulation may not be possible.
    Press
    Enter
  • 12
    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Press
    Enter
  • 15

    Agreement Terms:

    • Payment must be made in FULL at the time of booking OR 2 half payments can be made; half the total fees paid when booking in and the remainder of the fees paid 1 MONTH prior to your Estimated Due Date.
    • Your Placenta is to be picked up or dropped off to Precious Placentas within 24 hours of birth, in a clean sealed container or double bagged in sealed glad bags.
    • Your Placenta MUST be refrigerated OR surrounded by loose ice within 3 hours of birth (preferably within 2 hours)
    • Your placenta must be kept refrigerated OR on ice the whole time prior to itbeing released to me.
    • Your placenta products are guaranteed to be ready within 48 hours of pick up/delivery (on average products are ready within 24 hours)
    • You will be provided with a safe reliable, and honest service.
    • Placentas cannot be encapsulated if they have been to pathology.
    • Placentas cannot be encapsulated if you or your baby present with a fever or infection.
    • Precious Placentas guarantees that you will receive the products you pay for.
    • Precious Placentas cannot guarantee the amount of capsules you will receive, as each placenta is unique and yields differently, on average a placenta may yield 90-150+ capsules.
    • Precious Placentas guarantees your placenta is handled, prepared and stored safely at all times.
    • Precious Placentas guarantees that only one placenta is ever processed at a time.
    • It is the client's responsibility to ensure the placenta is handled and stored correctly after birth and prior to Precious Placentas receiving it.
    • In the event of a placenta being unfit for consumption you will receive a full refund less the $50 booking fee.
    • In the event of your placenta being unfit for consumption you may be able to still have keepsakes made and a partial refund given.
    • In the event that you decide you do not wish to encapsulate PRIOR TO birthing, a full refund less $50 will be given.
    • In the event that you decide you do not wish to encapsulate but processing has begun by Precious Placentas, I will cease preparation but a refund will not be given, The Client will have to pick up the placenta ASAP.
    • Finished placenta products will not be released unless full payment has been made.
    • Delivery fees may be applicable and you will be notified of this at the time of booking.
    • Precious Placentas will pick up your placenta from the prearranged location, be that hospital or your place of residence, at an agreed upon time.
    • Precious Placentas does not pick up placentas between the hours of 8pm and 7am unless otherwise organised.
    • If your finished products are ready after 5pm Friday they will be express posted to you the following Monday morning unless the Monday is a public holiday, then your products will be posted on the next avaliable day.
    • This service has not been evaluated by the TGA! The services offered are not Clinical, pharmaceutical or intended to diagnose or treat any condition. Clients who choose to utilize these services take full responsibility for their own health and for researching and using placenta products.
    • IMPORTANT NOTICE! You will have to ENSURE your Doctor or Midwife knows and understands that you wish to keep your placenta. The best way to do this is to mention it when you go for one of your antenatal visits, ask them to make a note of it on your file and even better if you have a birth plan and it is stated on there. – That way your placenta will not be accidentally discarded. ALSO letting the hospital staff know or (again having it on your file) that I will be picking up your placenta ( if that is the case) allows me to easily pick it up without any confusion from hospital staff and this way you will go undisturbed bonding with your precious new babe or babes!
    • Please know that if your placenta is taken to pathology for any reason I am unable to proceed with the encapsulation process. I follow strict safety and sanitation guidelines and in order to keep you safe, I cannot risk processing a potentially mistreated placenta. If your Doctor requires your placenta to go to pathology you may be able to request they simply take a sample (in front of you, so you are aware of how they took the sample) therefore allowing you to keep the rest of your placenta.
    Press
    Enter
  • 16
    If you click NO booking cannot proceed. PLEASE ALSO SIGN BELOW
    Press
    Enter
  • 17

    Storage Instructions:

    *Its easiest if you remind your care provider that you wish to keep your placenta at one of your prenatal appointments (even better if you ask them to note this on your file).

    *It also helps if you can make one of your support people the "placenta person" so you don't have to think about organizing the placenta so soon after birth :)

    1. Be prepared with a small esky (Kmart sells the perfect one for $15, alternatively Bunnings have the same for more $)
    2. All hospitals will provide a clean, sealed, labelled container to place your placenta into. (If they don't they will "bag" it for you)
    3. You will need loose ice to keep your placenta cool, Most hospitals will also provide ice/icepacks, again always best to check this with your provider at an appointment if possible. *Some hospitals are fabulous and will even allow you to store your placenta in the fridge.
    4. Placenta MUST be on ice or in the fridge within 4 hours of birth, if in doubt about when your placenta can be brought to me, have a support person take it home and freeze it straight away.
    5. Call or message me once you have given birth and I will be in touch to arrange pick up. - Reminder I cannot pick up in the middle of the night or wee hours of the morning I will respond after 7am.


    *I cannot process a placenta that is older then 48 hours (Unless it was handled properly and frozen within hours of birth)
    *I cannot process a placenta that is taken to pathology as I cannot guarantee that they treat it in a safe(hygienic) manor, If they want to take your placenta to pathology ask them to take a sample of it in front of you instead.

    *I cannot process a placenta if you or baby have had a fever or infection.

    There's no need to stress, this is almost always a straight forward process, even when you encounter a care provider who hasn't heard of encapsulation before or thinks it is "different".


    Please let me know if you have any questions,

    Warm Regards,
    Tessa Bobir

    Press
    Enter
  • 18
    Clear
    Press
    Enter
  • 19
    Press
    Enter
  • 20
    Press
    Enter
  • 21
    mention any friend/practitioner referrals here for your discount!
    Press
    Enter
  • 22
    Press
    Enter
  • 23
    Press
    Enter
  • Should be Empty:
Question Label
1 of 23See AllGo Back
close