Placenta Encapsulation
Thank you for choosing Compassionate Care Doula Services for your placenta encapsulation!
Servicing all of Bluffton, Beaufort and surrounding areas within a 60 mi radius. I will travel further for an additional fee. You will receive an email from me within 24 hours of completing this form. If you do not receive an email within 24 hours, I may not have received it. Please resubmit the form, or contact me. You can reach me with questions or comments at 631-268-4119 or e-mail me at compassionatecaredoula123@gmail.com
I am an Independent Placenta Service Provider. I received my training from Traditional Doula Arts. I adhere to a strict protocol in accordance with the OSHA Blood borne Pathogens Standard 29 CFR 1090.1030. I have completed my training and hold a certification of completion in Blood-borne pathogens & infection control for Doulas, Midwives and Placenta Encapsulationists.
Please know that all information will be held in strict confidence.
Thanks again for choosing Compassionate Care Doula!

Please fill out this Placenta Intake form to get started!

Where will you be giving birth? * *
Your answer
Care Provider's (Dr. or Midwife) Name * *
Your answer
First and Last Name *
Your answer
Placenta Intake Form
Please fill out the information below so I know best how to serve you. If you any questions feel free to contact me
Call/text 631-268-4119 or email compassionatecaredoula123@gmail.com
Doula's Name/Referrals Name *
Your answer
Your Home Address * *
Your answer
Phone Number * *
Your answer
Partner's Name Number or Another Contact # * *
Your answer
Email Address * *
Your answer
Baby's due date* *
Your answer
Do you have any allergies to: * *
Required
Are There any allergies that you would like me to be aware of *
Your answer
Is there anything that you would like to tell me about your pregnancy, birth or Placenta? *
Your answer
Do you have or have you ever had *
Required
Have you taken any Medications during pregnancy? Please be specific *
Your answer
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