Liability Release
Read the information below and sign the form at the bottom.
I, the Undersigned, choose to ingest my placenta under my own free will and accept any and all side effects that may arise. I understand that ingesting my placenta does not guarantee any medical outcome and is not regulated by the Federal Drug Administration. I understand that the below are contraindications for ingesting my placenta (meaning it is not recommended to ingest my placenta if any of these circumstances are present):
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smoking or drinking during pregnancy
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maternal or neonatal infection during or shortly after childbirth
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chorioamnionitis (infection of the placental membranes)
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improper storage of the placenta
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Group B Strep positive
I understand that I need to inform Sacred Openings, LLC if any of the above situations become present at any point during my perinatal period.
Sacred Openings, LLC is released from any liability in any outcomes that arise from me ingesting my placenta.