Service Cancelation
Service Cancelation
Name of Client
Name of Client
First
Last
I am canceling the following service contract:
Placenta Encapsulation Services
Postpartum Doula Services
Birth Doula Services
Reason for Cancelation: Please provide details for the reason services are being canceled.
If the reason is due to medical concerns, please upload or send via email documentation of the event or 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
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.
By signing below you are signifying that you, the Client, are releasing Great Expectations Birth LLC from the agreed upon services and and may make no claim that services were not provided as agreed to by Great Expectations Birth LLC.
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or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
Date
Date
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