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

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Placenta Encapsulation Intake Form

Basic Information


Pregnancy Information

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

More Information


Placenta Encapsulation Price

Please Choose the Option that Applies to You

**Payment may be made in full or be done through a deposit and payment plan


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 Flavor Would You Like Your Gel Capsules To Be?
What Type of Gel Capsules Would You Like?
Would You Like An Umbilical Cord Keepsake? (See Explanation Below)

**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
Extended Pickup
Mail it In!

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

Salt Lake and Wasatch Counties

($25 Trip Fee)

Summit, and Cache Counties

($50 Trip Fee)

You Pay Shipping

**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.

Placenta Pick Up Options (Pick One)
We Come to the Place of Birth Within 24 Hours of the Baby's Birth. Once the Baby is Born, We Can Confirm Your Location for Pick Up. (See Placenta Pick Up and Drop Off Process for More information Under Placenta Encapsulation Tab)

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).


Payment can be made in full or we accept a $50 deposit. The remaining balance will be invoiced. Remaining balance is due at or before pill delivery. We also have payment plans that can be worked out directly with us. If you would like to do a payment plan, contact Shannon at 801-309-3636.

Choose Your Payment Option Below

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