Service Cancelation

Name of Client Name of Client First Last
I am canceling the following service contract:
Reason for Cancelation: Please provide details for the reason services are being canceled.

If you are canceling placenta encapsulation, please let us know the medical contraindication for services and upload documentation of the diagnosis.
Documentation
If you ordered the Classic or Deluxe encapsulation package, please return the unused kit to: Great Expectations Birth, 114 West Elm Crescent, Spring, Texas, 77382

If you ordered the Classic or Deluxe encapsulation package, please return the unused kit to: Great Expectations Birth, 114 West Elm Crescent, Spring, Texas, 77382 Yes, I received a kit and will be shipping it back No, I did not receive the kit as part of my order My kit is not unused and will not be shipped back
By signing below you are signifying that you, the Client, are releasing Great Expectations Birth LLC from the agreed upon services and may make no claim that services were not provided as agreed to by Great Expectations Birth LLC.

Draw or Type

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Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
This contract shall acknowledge the Client & Great Expectations Birth LLC's mutual agreement to terminate the contract for services, without further recourse or legal obligation by either party. The termination of services does not amend the original payment policies agreed to at contract signing. Non-refundable payments remain non-refundable.