PE Intake Form

DISCLAMIER- Placenta pills are not intended to cure any type of health disorder or disease. A qualified healthcare provider must be informed if the mother has a history of depression or is showing signs of post partum depression or psychosis as these require medical attention beyond the scope of the placenta encapsulator. Please be advised that the placenta pills are strictly intended to aid in the support of post partum recovery and do not replace pharmaceuticals or psychological assistance required to treat any type of health concern.

Payment/deposit arrangements will be discussed following the submission of this form. Thank you.


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