Thank you for choosing Dallas Placenta Encapsulation!  Please enter your information in the form below. Once the form has been submitted, you should be directed to a new window and the PayPal payment portal.

We are aware of  error messages populating instead of the payment portal and are working diligently with our host to correct this issue. With this in mind, you will receive an email confirming the receipt of your form and details for alternative methods of payment. We apologize sincerely for any inconvenience this may cause you.

Please contact 940-230-6690 for immediate assitance with forms or payment questions.