Placenta Services Questionnaire


Name *
Name
Estimated Due Date *
Estimated Due Date
What are your plans for transport of your placenta? Keep in mind, many birthing facilities require the placenta to leave the hospital prior to your transfer to the postpartum recovery area (about 2 hours after birth).
Please indicate your comfort with the following statements.
Please indicate your comfort with the following statements.
I would like to be home during the encapsulation process.
I am comfortable seeing and/or touching my placenta.
My family members are comfortable with this process.
I do not want to be involved in the encapsulation process.
Please check all that may apply.