Placenta Services Booking Form
Thank you for choosing Tree of Life to honour your placenta and postpartum health

Important Disclaimer: We are not a medical body and do not claim to prevent, treat, or diagnose any illness or symptoms during pregnancy, birth or the post-natal period. Clients that choose to utilise our services assume full responsibility for their health and for researching information regarding our placenta services.

By choosing to work with Tree of Life - Nurturing Birth and Beyond, you agree to the above.

Name
Your answer
Phone
Your answer
Email
Your answer
Expected Due Date
Your answer
Planned Birthing Location
Your answer
Home Address
Your answer
For our own protection, we MUST have honest answers to the following question
Have you ever tested positive for HIV, Hepatitis B or Hepatitis C?
For your own protection, we must have an honest answer to the following question
Do you smoke?
Why are you interested in placenta remedies?
Your answer
Where did you hear about placenta remedies and how did you hear about Tree of Life in particular?
Your answer
Have you ever suffered from baby blues or postnatal depression before?
Your answer
Have you read thoroughly through the document titled ‘IPEN Placenta Encapsulation Information Guide for Expectant Mothers'?
Your answer
Please specify the services you require (all amounts are with encapsulation)
Collection/Delivery fee
What shape would you like your cord keepsake to be?
Submit
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