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Meet the Team
Midwifery
Midwifery FAQs
Request a Midwifery Consult
Lactation Services
Lactation Client Intake Form
Craniosacral Therapy/Myofascial Unwinding
Adult Craniosacral Therapy/Myofascial Unwinding Client Intake Form
Pediatric Craniosacral Therapy/Myofascial Unwinding Client Intake Form
Doula Services
Birth Planning
Doula Client Intake
Doula FAQs
Doula / Labor Support Packages
Doula Gift Certificates
Placenta Encapsulation
FAQs about Placenta Encapsulation
Placenta Benefits
Placenta Encapsulation Resources
Registration for Placenta Encapsulation
Placenta Encapsulation Gift Certificates
Testimonials
Blog
& More…
Childbirth Classes
The Storks Complete Childbirth Course
TGS Childbirth Course FAQS
Registration for TGS Childbirth Course
Childbirth Education Gift Certificates
Childbirth Course Evaluation
Spinning Babies® Parent Class
Spinning Babies Registration
Doula Workshops
Registration for Doula Workshops
Doula Training Gift Certificates
Registration for Placenta Encapsulation
GreenStork2016
2017-12-22T21:32:07+00:00
Registration for Placenta Encapsulation
Thank you for choosing us to Encapsulate your placenta.
Encapsulation Registration
First Name
*
Last Name
*
Guess Date/ Estimated Due Date
*
I will be using Traditional Chinese Medicine method to encapsulate my placenta.
Traditional Method
Choose a method for pick up or delivery
*
I will deliver the placenta to Stephanie.
I want Stephanie to pick up and drop off the placenta.
I would like to discuss with Steph to make other arrangements for pick up and delivery.
We charge $.50 a mile from Bemidji, MN to pick up and deliver the placenta. Pick up in Bemidji is included in the cost. Unless other arrangements are made with Steph.
E-mail
*
Phone
*
Pick Up and Delivery Address
*
Address Line 2
City
*
State
*
Zip Code
*
Are You Planing a Home or Hospital Birth?
*
Home
Hospital
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