By signing below I understand and acknowledge the following: Placenta encapsulation is not intended to prevent or treat any physical ailment, diseases, or symptoms. I chose services for my own personal, spiritual or cultural beliefs, at my own free will. I understand the nature and potential risks involved and related to ingesting or otherwise using placenta products; that I hereby assume all risks, known and unknown, foreseeable and unforeseeable, in any way connected with ingesting or otherwise using placenta products; I accept full responsibility for any risk, liability, injury, loss, damage or death in any way connected with using placenta products for me and my family. Furthermore, I hereby release and hold harmless Midwest Placenta Encapsulation LLC (hereafter referred to as MPE) and/or owner, Casey Merrell (hereafter referred to as CM) from liability whatsoever, any and all liability or claims which may arise from placenta services/products inclusive of, but not limited to, any undesired effect of consumption, injury or death resulting from exposure to allergies, food borne illnesses, or choking.
This service has not been evaluated by the FDA. Services offered are not clinical, pharmaceutical, or intended to diagnose or treat any condition. I understand and agree that the MPE/CM is not acting in the capacity of a doctor, healthcare provider, licensed dietician or nutritionist, psychologist or other licensed or registered professional and will not diagnose, treat or prescribe for any condition. I do not hold MPE/CM liable for the intended uses, dosage, storage and other information. I understand all content including text, graphics, images and information, communicated by or available through the MPE/CM is for general information purposes only. I agree and understand that the MPE/CM makes no representation and assumes no responsibility for the accuracy of information given. I understand benefits stated are not guaranteed, and additional support or medical council may be needed. I agree never to disregard professional medical advice or delay seeking medical treatment because of information given by MPE/CM.
I understand services and fees are for the preparation/encapsulation of placenta, not for the sale of the placenta itself for consumption. I understand that my placenta has been handled by MPE/CM, in a personal, non-commercial kitchen that has not been accredited or approved by OSHA or any Food Safety and Handling Governing Board. I waive liability of transmission of any communicable disease (influenza, COVID-19, etc.). I also acknowledge that there are no statewide/nationwide regulations for placenta services and understand that the Department of Public Health and/or the Division of Environmental Health and Protection do not have the authority of completing in-home licensing and inspections for placenta services and has not done so for MPE/CM.
I give permission for my placenta to be transported/ handled/processed by MPE/CM into chosen products/methods/services. I do not hold MPE and/or Casey Merrell responsible for mishaps that may happen while transporting the placenta/capsules/keepsakes (i.e. car accident, detainment, damaged packages, lost/late packages, shipping mishaps). I understand shipping/completion timeframes may vary due to a variety of factors. I will abide by freezing/shipping instructions. I understand improperly handled placentas are susceptible to spoilage. If placenta fails temperate check, encapsulation is not recommended.
I understand that final product(s) will vary from those shown, such as the number of capsules, keepsakes, etc. I give permission for photos/videos of placenta/products to be taken at any stage of the process and used as desired marketing/social media. I give permission for MPE/CM to share facts and/or photos about state of placenta with additional professionals if needed.
I and my successors, agents or assigns, hereby forever and unconditionally releases MPE/CM, its owners, officers, employees, agents, successors in interest and insurers, heirs, executors, administrators, assigns, agents, trainers, placenta preservation certifying association, representatives, and all others acting on their behalf (hereinafter referred to as the “Released Parties”), from any and all claims, actions, damages to your person and/or property or that of your family, liabilities, injuries, losses, costs, and expenses, including, without limitation, attorney’s fees, in any way arising out of, or resulting from, my voluntary use of placental services and products. I further acknowledge that the MPE/CM is in no way liable for any injury resulting from my own conduct or behavior.
I confirm that I am knowingly free of any STDs/STI/HIV or any other blood-borne pathogen/disease/contraindication that could make placenta services not recommended. I understand if any type of infection presents itself after birth, ingestion is not recommended. I agree the balance of placenta services/products must be paid in-full. I agree to a non-refundable shipping kit deposit of $50 which must be paid prior to receiving the shipping kit. Refund (not including non-refundable shipping kit cost) may be granted before services rendered, partial refund may be granted depending on stage of preparation at time requested, no refund will be granted once contracted services have been completed. Completed products may be held by MPE/CM for failure of payment.
By signing below, you acknowledge that you have had an opportunity to read/discuss the contents, and have reviewed by 3rd party if desired, and you understand, accept and agree to abide by the terms hereof. This agreement shall be binding.
Jump to
Midwest Placenta Encapsulation 