Reserve your spot

We can provide services to Central Alberta. The following areas are included in our prices:

  • Red Deer
  • Blackfalds
  • Sylvan Lake
  • Penhold
  • Lacombe


For an additional fee we can do pick ups and delivery in:

  • Rocky Mountain House
  • Wetaskiwin
  • Stettler
  • Innisfail
  • Olds
  • Pine Lake
  • Ponoka
  • Bentley
  • Rimbey


If your location is not listed, please contact us to see what additional fees would be.

You can review the different methods used for encapsulation here.

Please do not send credit card numbers in the form below. If you would like to pay with a credit card for your placenta encapsulation, please indicate that and we will send you an invoice. Thanks!


($195 for Central Alberta Doulas birth clients)

  • encapsulation using either the Traditional Chinese Method (TCM) or raw preparation. (Half and half available for an extra cost.)
  • cord keepsake
  • placenta print
  • a guide to placenta capsules and postpartum recovery
  • all delivered in a re-usable gift bag


  • 1/2 & 1/2 preparation - $25
  • Twin or Triplets (extra placenta(s)- $25
  • Chocolates, one dozen - $20
  • Tincture, 4oz bottle - $15
First Name:*
Last Name:*
Cell phone:
Home phone
E-mail Address:
Estimated Due Date *
Baby's Gender, if known
Baby's name, if chosen
Care provider
Planned place of birth?*
Expecting twins/triplets?
Mother’s Date of Birth
Is this your first pregnancy?
Have you had previous placenta encapsulation services?
If yes, did you see the results you were hoping for?
Do you have any transmittable diseases?*
What are you hoping to achieve by encapsulating your placenta?
Do you have any allergies?*
Do you have a history of depression?

A. I understand that the $50 non-refundable deposit must be paid in order to hold my spot. The remainder of the total must be paid on or before my 37th week of pregnancy. In the event that my placenta cannot be encapsulated (care provider request it ALL be sent to the lab, damaged during birth, etc) my fees minus the deposit will be refunded. My placenta will not be picked up before payment and my completed form is received.

A - read and agreed (initials)*

B. I understand that the placenta capsules I will be taking do not replace the need for pharmaceuticals or psychological help if I have pre-existing health concerns or if I begin to experience any health issues and that I will seek medical attention if I begin to experience any acute or unusual physical or mental health problems.

B. read and agreed (initials)*

C. I understand that the it is my responsibility to make sure the placenta is properly packaged and stored prior to my encapsulator picking it up. I understand that failure to properly cool and store my placenta could result in an illness upon taking the capsules. I also understand that I must inform my encapsulator of anything that could prevent my placenta from being able to be used (certain medications, infection, left un-cooled for more then 4 hours, my placenta was sent to the lab)

C. read and agreed (initials)*

D. I consent to a picture(s) of my placenta stamp, cord keepsake or finished capsules being posted on the website or used in social media. No identifying names or information will be used at any time.

*this is optional to clients

D. Yes or No*
D. read and agreed (initials) *
Raw or TCM?*
Extras: 1/2 & 1/2 preparation - $25 Twin or Triplets - $25 Chocolates, one dozen - $20 Tincture, 4oz bottle - $15 (please list items wanted)
Do you live outside our delivery area that is included in the cost?*
Additional cost for pick up and delivery
Coupon Code
Total Due*
Deposit Paid


Paid in full

We accept credit cards or email money transfers,

If paying by credit card you will receive an invoice within 2 business days.

For email money transfers please send them to and use the password “placenta”. You can send email transfers straight away after submitting this form. Once this form and payment are received you will get an email with further instructions.

Method of Payment *
How Did You Hear About Us?
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