You only get one placenta, use it for your self-care during your postpartum recovery.

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This form does not collect payment. Upon completion of form, you will be emailed an invoice within 24 to 48 hours.

Placenta Encapsulation Intake Form

Basic Information


**Encapsulation is safe for up to 6 months after birth has long as placenta has been frozen within 3 days of birth

Pregnancy Information

More Information

Your Placenta Encapsulation

Placenta Encapsulation Methods

Steamed Method
Raw Start Method

The placenta is steamed to 160 degrees before being dehydrated at 140 degrees for a minimum of 12 hours.

This method is prepared by thinly slicing the placenta raw prior to dehydration. After dehydration the placenta is then ground into a fine powder and placed into capsules.

Placenta Tincture

A small piece of placenta is placed within grain alcohol to create a tincture. This tincture can be used when the placenta pills are finished to offer a similar support to the mother.

Customize Your Placenta Pacakage

How Would You Like Your Placenta Prepared? (Pick One)

Add Ons

Would you like to Keep the Potential Benefits From Your Placenta, After Your Capsules Are Gone, by Adding the Placenta Tincture? (Explained in the Graphics Above)
What Type of Gel Capsules Would You Like?
What Flavor Would You Like Your Gel Capsules To Be?
Would You Like An Umbilical Cord Keepsake? (Free)

**We can use the umbilical cord that is attached to the placenta to make a keepsake. Depending on the amount of umbilical cord available, we create a shape and dehydrate it for you.

Placenta Pick Up Information

We Service the Whole State of Utah (through pick up or mail in)

Local Pick Up
Out of Area Pickup

Weber, Davis, Morgan, Utah and Box Elder Counties

Salt Lake County

($25 Trip Fee)

Mail it In!

You Pay Shipping

Summit, and Cache Counties

($50 Trip Fee)

Extended Pickup

**All travel costs are estimated based on your planned delivery location. Please note that if your location changes, you may be refunded the excess or charged additionally based upon pick up location. Any additional fees will be discussed prior to pickup.

How Will You Be Getting Your Placenta to Us?
If you would like us to pick up your placenta, where will the pick up location be?

Placenta Product Drop Off Information

We Service the Whole State of Utah (through pick up or mail in)

Local Drop Off

Weber, Davis, Morgan, Utah and Box Elder Counties (Included)

Out of Area & Extended Drop Off

For anyone who is not  in the local drop off areas, we mail your placenta products to you within a few days of placenta pick up.

($10 fee). 

**All travel costs are estimated based on your location when products are ready. 

Placenta Drop Off Options (Pick One)
Capsules will be delivered or shipped within 72 hours of Baby's
Birth. (We use USPS Priority Shipping, so your products will arrive within a few days of shipment.)

***I understand that the act of ingesting placenta in any form has not been tested, nor approved by the FDA, and I ingest this at my own risk. The services offered are not intended to diagnose or treat any condition. By choosing to utilize the services on this page I take full responsibility for researching and using the remedies. Furthermore, I release Bloom Birth Utah, LLC from any and all liability for any effects I may experience after choosing to ingest the capsules. I understand that no refund will be given for any reason once I take possession of the finished product (placenta capsules, cord keepsake, and/or placenta tincture).

Thanks for choosing us!