By submitting this form, I certify I have asked Jane Knox of JMK’s Breastfeeding Support to prepare my placenta into capsule form for my own use.

I understand that…

1.      I am not buying my placenta but paying for encapsulation and/or tincture/essence service only.

2.      The placenta will be handled according to proper safe food preparation from the birth.

3.       I am not carrying any transmittable diseases such as Hepatitis B, Hepatitis C, Syphilis or HIV/AIDS.

4.      Clients who choose to utilise these services take full responsibility of their own health and for researching and using the remedies provided by this service.

5.      Placenta encapsulation in itself is experimental in nature and whilst the benefits of consuming the placenta post birth are based on research studies, article, testimonials from new mothers, this research is ongoing and JMK’s Breastfeeding Support does not give any warranty or representation that these benefits are guaranteed.

6.      All methods of decontamination and disinfection of equipment used by JMK’ Breastfeeding Support are practised to Australian Government Safe Food handling, Blood Borne Pathogen guidelines and regulations.

7.      JMK’s Breastfeeding Support retains ownership of any photographs taken of the client’s placenta which may be used anonymously for education, advertising and promotional purposes. The client shall inform JMK’s Breastfeeding Support if they do not want photos to be taken of her placenta.

8.      JMK’s Breastfeeding Support does not determine whether my placenta should be consumed and makes no guarantee of my personal results from the capsules. Infection during labour or delivery would be a contradiction for encapsulation.

9.      The capsules should not be taken during times of illness, such as colds, flu’s, mastitis or any other infection. I understand that taking the capsules can make these conditions worsen.

10.   JMK’s Breastfeeding Support does not take responsibility for damaged or lost placentas before the placenta comes into our care.

11.   JMK’s Breastfeeding Support aims to prepare the placenta within 3 days after birth. However, we will not be held accountable should circumstance arise where the placenta encapsulation cannot be completed until an agreed date and time.

12.   The capsules will be returned to me within 24 – 72 hours of me releasing, my placenta to JMK’s Breastfeeding Support.

13.   The Documents: Information Guide for Expectant Mothers, Placenta Chilling Instructions and Appropriate Placenta Care will be emailed to you upon receiving the deposit and booking form.

14.   Clients may consent to complete an on line feedback survey sent by email 6 weeks following the encapsulation and the client agrees to answer the questions honestly to help provide testimonials for JMK’s Breastfeeding Support.

I understand that:

1.      I must notify Jane Knox of JMK’s Breastfeeding Support of my birth as soon as possible on 0431137046 to make arrangements for collection and safe delivery of my placenta.

2.      It is my responsibility to inform hospital staff or midwife if home birth that I wish to retain my placenta. You may have to sign a release form from the hospital, and you should plan in advance for any requirements of the release of your placenta.

3.      The placenta must be double bagged (2 freezer strength zip lock bags) and placed in a sealed container and put on ice in a cooler bag or refrigerated to keep it cool within 2 hours of birth of the placenta.

4.      If there is any reason that the placenta cannot be prepared for more than 3 days, it should be frozen within 2 hours of birth ie: doubled bagged and stored in container as above and placed in a freezer. A frozen placenta will require an extra one or two days as it has to thaw in fridge for minimum 36 hours before preparation can be started.

In the event that your placenta is unavailable to you (sent to pathology or infection) any fees paid including the deposit will be refunded in full.
If you chose to terminate this contract less than 2 weeks before your EDD or after releasing your placenta to me, but before any preparation has begun, your placenta will be returned to you for disposal. Your $50.00 deposit will be retained by JKM’s Breastfeeding Support but any other portion of fees paid will be returned to you.
There will be no refund and payment due in full once preparation has begun, even if you choose not to take delivery of the finished product/s.