Bookings — Yoni To Earth

Booking Form

Please only complete this form if you intend on booking this service as you will receive an invoice. Please do not book if you are not committed to going ahead.

Thankyou.

For all enquiries or questions, please contact me here.

What service would you like?

Name

First Name

Last Name

Number

Partners Name or Alternative Contact

First Name

Last Name

Partners/Alternative Contact Phone

Estimated Due Date

Where are you planning on birthing?

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any allergies or blood related disorders?

Booking Terms & Conditions

I understand that Yoni To Earth is providing a “service”, not a product. (The service is “processing your placenta, into pill form for consumption by yourself at your own risk.) I also understand that the practice of placental encapsulation is not TGA approved. I understand that this process is performed using only disinfected, sanitised and disposable (if possible) equipment and while wearing food grade gloves at all times. Yoni To Earth only use vegetable capsules which are suitable for vegans. It is my responsibility to make sure the placenta is not disposed of and Yoni To Earth strongly advises that I place this request in my birth plan and remind my care providers. While every effort is made to process the placenta, I understand that on rare occasions there may be an issue with the placenta that prevents it from being processed. If this occurs, I understand that the placenta will be returned to me to be disposed of as per the hospital release form conditions. 50% of the package fee will be refunded if the placenta is unable to be processed. The pick-up and delivery fee will still apply in order to cover petrol costs and time incurred. Pick-ups and deliveries will only be made during business hours unless otherwise convenient for Yoni To Earth. Please ensure your placenta is properly stored below 4 degrees celsius until pick up. Yoni To Earth will not be held accountable for any allergic reactions or health problems due to not notifying in the booking form. Please supply accurate information. ***The details provided on this agreement are “private and confidential” and will only be used for the purposes of preparing your placenta. Please be aware that your honesty in completing this form is appreciated for the safety and wellbeing of yourself, your baby and the employees of Yoni To Earth.***

I agree to the Booking / General Terms & Conditions.

Booking Form

Contact Sylvie.