Placenta remedies booking form

Where are you planning to birth?
Have you spoken to your midwife about your choice to encapsulate?
Have you ever tested positive for AIDS, HIV, Hepatitis B, Hepatitis C or CJD?

For the health and safety of yourself and your Specialist we must have an honest answer to the above question

Have you tested positive for Group B Strep in this pregnancy?

Please update me if this changes prior to your birth

Have you smoked during this pregnancy?

For the health and safety of yourself we must have an honest answer to this question

Have you been prescribed regular medication during your pregnancy?

If YES, you must seek approval from your prescribing doctor before your booking can be accepted

Which service do you require?

Michelle Parkin

07387203831

©2019 by Michelle the Doula.