Treasured Birth Services - Belly Binding Client Contract
Please complete this form to reserve belly binding services. I will be in touch with you within 24 hours of receiving your completed form to confirm booking and discuss payment.

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Full Name *
Email *
Phone *
Home/Street Address *
Estimated Delivery Date/Birthing Date *
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Which package would you like to purchase? *
I serve all areas within 25 miles of West Point, Utah. If you are outside this radius, there is an additional charge of $1 per mile.
Pant size (before pregnancy) *
Would you like the optional warming paste? *
Ingredients include: turmeric, bentonite clay, black pepper, cloves, ginger, cinnamon, calendula, and grapeseed oil.
As your Belly Binder, I will:

- Provide you with a new wrap
- Come to your home and bind you
- Teach you how to continue binding yourself
- Discuss a self-care plan for the newborn stage
- Provide services within 7 days of delivery
- Provide an herbal salve, upon advanced request, for no additional cost

Please initial to show that you have read and understand your belly binders responsibilities as listed above. *
I ask that you:
- Please try and schedule your Belly Binding services around 37- 40 weeks gestation. This allows enough time for your bind to be made, and for me to ensure you are booked in my schedule.

- Understand that services will be completed at the agreed upon time. If for some reason, timing needs to change, we will arrange another mutually agreed upon time.

- Understand that unforeseen circumstances (i.e. family emergency, illness, weather, acts of God) does not negate services. I will make all attempts to provide you with appropriate services.

- Provide payment via cash/check or paypal, prior to date of services. Payment is final and may not be refunded unless I, Hanan Webster, default on the contract, or a medical reason permits you from being bind.

- Disclose any illnesses, physical complications or concerns prior to service.

- For best results, take a warm shower before binding and applying paste. Be sure to drink water and/or herbal tea frequently while wearing the bind.
Please initial to show that you have read and understand the above statement about your responsibilities. *
Disclaimer
As a non-clinical support person, I Hanan Webster can make no medical claims for the outcomes of belly binding services, nor cannot guarantee results.

Belly binding is most effective when the wrap is worn for 8-12 hours daily for approximately 40 days and accompanied by gentle, postpartum-appropriate exercises. Belly binding after the first six weeks postpartum may not be effective. Belly binding is
also MOST effective when the client remains in bed the majority of her time wearing it. The more you move, the less effective it may be. The binding is intended to be worn as the client rests and heals in bed.

Essential oils or Traditional Warming paste may be used, but are not meant to treat or cure any medical conditions. Traditional Warming paste includes any combination of the following: black pepper, cinnamon, turmeric, ginger, clove, redmond clay, grapeseed oil, and calendula. Only client's essential oils will be used, if desired.

By signing this contract, you (the client) take full responsibility for your health and medical care. Please notify me of any unusual pain, circumstances of the recent labor/birth, applicable medical concerns, and/or allergies experienced. I will not attempt to diagnose any symptoms discussed, but will direct the client to the appropriate medical care provider as needed.

I recommend all postpartum women make an appointment with their local physical therapist and/or chiropractor for pelvic floor assessment after having a baby. The client understands that belly binding is not recommended with the following conditions:
severe pelvic organ prolapse (bladder, uterine, etc.), emergency hysterectomy, severe diastasis recti (abdominal separation), and abdominal hernia.

I am not a licensed massage therapist, herbalist, or aromatherapist and do not claim to practice as one. Touching is limited to contact necessary to apply essential oils or warming paste and wrap the binding around the client's abdomen. My sole purpose is to provide for the physical comfort and emotional support of the postpartum mother.

Knowledge imparted during the course of the belly binding service is based on my experience as a birth doula, a mother, and as a professional postpartum belly binder. This advice should not be taken as medical advice, and any action taken/results had
based on my suggestions is the client's responsibility and liability.
Please type your name as your signature to complete your contract for services. Thank you! *
I the undersigned agree to save Treasured Birth Services/Hanan Webster harmless from any and all liability, liens, claims, demands, damages, expenses, fees, costs, fines, penalties, suits, proceedings, actions and causes of action of any and every kind and nature arising or growing out of or in any way connected with participation in BELLY BINDING. Treasured Birth Services/Hanan Webster does not give medical advice and you agree to consult a doctor or midwife before making any medical decisions in regards to the use of Belly Binding.
How did you hear about Treasured Birth Services? *
If referred by someone specifically, who can I thank?
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