Unique Ultrasound understands the importance of proper medical care for both expectant mothers and fetus. Therefore, in order to provide our patients with an appropriate, meaningful ultrasound screening, Unique Ultrasound requires that you:
1. Certify that you are under the care of a physician or other health care provider, and that you are not obtaining this ultrasound as a replacement for, or in lieu of, standard prenatal medical care.
2. Notify your current physician or health care provider regarding the ultrasound you receive from Unique Ultrasound as a further condition to receiving limited diagnostic screening ultrasound services from Unique Ultrasound, you hereby acknowledge, understand and agree to the following statements:
You understand that the quality of this ultrasound and the DVD depends upon many factors including maternal body habitus, developmental stage and fetal position, and for those reasons we cannot guarantee the quality.
You understand that since Unique Ultrasound performs a limited medical diagnostic study with each ultrasound, and that since this ultrasound is not performed solely for the images you will receive as a byproduct of this limited diagnostic study, refunds are not available for any reason.
This ultrasound is an elective procedure that I have voluntarily requested, and is not intended to take the place of a diagnostic ultrasound or any other test or treatment that has been or may be recommended by my healthcare provider.
The technologist who performs this ultrasound while qualified to provide such ultrasound services, is not qualified to interpret, diagnose medial conditions from, or otherwise offer medical conclusions regarding the images produced.
You understand that you are responsible for contacting your own healthcare provider if you have any questions concerning this ultrasound or any other aspect of your pregnancy.
As evidenced by your signature below, you understand that factors beyond Unique Ultrasound’s control may also affect the ability to accurately determine the gender of the fetus, and that Unique Ultrasound can provide no warranty or guarantee as to the accuracy of any such determination. IN CONSIDERATION OF THE SERVICES RENDERED, YOU AGREE TO RELEASE UNIQUE ULTRASOUND, ULTRASOUND TECHNOLOGISTS, OWNERS, AND EMPLOYEES FROM ANY AND ALL CLAIMS OR CAUSES OFACTION FOR INJURY, HARM, DAMAGE OR OTHER LIABLITY WHICH RESULTS FROM, OR ARE ALLEGED TO HAVE RESULTED FROM, THIS ULTRASOUND, INCLUDING BUT NOT LIMITED TO, THE FALIURE OF UNIQUE ULTRASOUND TO ACCURATELY DETERMIEN FETAL GENDER OR OTHER CHARACTERISTICS, AND ANY DAMAGES OR INJURIES RESULTING FROM, OR ALLEGED TO RESULT FROM ULTRASOUND WHICH ARE NOT NOW NOT KNOWN TO OCCUR.
“I have carefully read this document and affixing my signature, I acknowledge that I fully understand and agree to its contents: