Name: Placenta TLC
Telephone: (021) 243 - 9155

Please Select Your Location:

There are additional courier charges for pick up outside of Cork. All other locations POA

Where did you hear about Placenta TLC?

Please Confirm The Following:

All the information you have given is correct and to the best of your knowledge.
You have thoroughly read and will follow all the guidelines that will be delivered to you to ensure your placenta is handled and chilled correctly.
Full payment will be made by cash / cheque or transfer upon collection of the placenta.
By using this form you agree with the storage and handling of your data by this website.
You agree to the Terms and Conditions.

To secure your booking we require a €50 non-refundable booking deposit.

Placenta Encapsulation Booking Form

Booking Form

For Your Own Protection We Must Have an Honest Answer to The Following Questions

Have you smoked during your pregnancy?

Have Your Ever Tested Positive For The Following:

Have Your Ever Tested Positive For Group B Strep?:

Do You Have Any Allergies?:

Please Indicate Your Capsule Type Preference:

Are you have a planned c-section? (Please Specify Date)

Please Indicate The Additonal Product/Services You Require:

Please Select Your Location:

Where did you hear about Placenta TLC?

Please Confirm The Following:

Learn More

Encapsulate Your Placenta

Booking Form

For Your Own Protection We Must Have an Honest Answer to The Following Questions

Have you smoked during your pregnancy?

Have Your Ever Tested Positive For The Following:

Have Your Ever Tested Positive For Group B Strep?:

Do You Have Any Allergies?:

Please Indicate Your Capsule Type Preference:

Are you have a planned c-section? (Please Specify Date)

Please Indicate The Additonal Product/Services You Require:

Please Select Your Location:

Where did you hear about Placenta TLC?

Please Confirm The Following:

@placentatlc