• Tummy Vision Check-In Forms

    Please click on SUBMIT at the very end. You will receive an email once completed.
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  • Tummy Vision Ultrasound Studio Waiver of Liability

    Tummy Vision Ultrasound Studio understands the importance of proper prenatal medical care for both the expectant mother and the fetus. Therefore, in order to provide our patients with an appropriate, meaningful ultrasound screening, Tummy Vision Ultrasound requires that you:{i) 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.

      As a further condition to receiving ultrasound services from Tummy Vision Ultrasound Studio, you hereby acknowledge, understand and agree to the following statements:

     - 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 your healthcare provider.                              

    - The technician who performs this ultrasound, while qualified to provide such ultrasound services is not a doctor, nurse or healthcare provider; and cannot interpret, diagnose medical conditions from, or otherwise offer medical conclusions regarding the images produced. Any measurements given are estimates only and not intended for medical use or diagnosis.

     - As used by Tummy Vision Ultrasound Studio, this ultrasound is intended to provide enhanced images for the purpose of viewing fetal movement in utero. The technician will make no attempt to guarantee a medically inclusive ultrasound or fetal well-being.

     - 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. Since we are elective, we do not share our images with healthcare providers.

    -If you are less than 6 weeks pregnant or we are not able to see baby you can return one time within two weeks of your original appointment for only $25.

    - Rescan appointments will be scheduled on a Monday through Friday and at the availability of Tummy Vision and their staff. The Rescan appointment must be completed within two weeks of the orginal appointment or the orginal appointment price will be charged.

    - If you are a no-show, cancel or reshedule your appointment to a later time within 4 business hours of your appointment you will be charged a $35 cancellation fee. If you miss your "Rescan" appointment and do not provide at least 4 hours notice you will be charged $35 for the "Rescan" appointment.

    - Upgrades to packages made from the checkin-in form are subject to availablity.

     - Images and video taken by Tummy Vision may be used for advertising and marketing purposes including social media. Client names and any personal information will be removed from the pictures or video for confidentiality.

    -Any items purchased or obtained via giveaway from Tummy Vision are meant for entertainment and should not be used by children. Tummy Vision is not responsible for any injury, harm or damages caused by items. We do not accept returns on heartbeat animals, clothes or shoes.

    - This waiver will apply to any future appointments with the same pregnancy including rescans/redo appointments.

      As evidenced by your signature below, you understand that factors beyond our control may also affect the ability to accurately determine the gender of the fetus, and that Tummy Vision Ultrasound Studio can provide no warranty or guaranty as to the accuracy of any such determination. You further understand that while ultrasound is believed to have no harmful effect on the mother or the fetus, future research or other information may disclose harmful or adverse effects that are presently unknown.

    IN CONSlDERATION OF THE SERVICES RENDERED, YOU AGREE TO RELEASE Tummy Vision Ultrasound Studio, ITS AGENTS; AFFILIATES,  DIRECTORS, AND EMPLOYEES FROM ANY AND ALL CLAIMS OR CAUSES OF ACTIONS FOR INJURY, HARM, DAMAGE OR OTHER LIABILITY WHICH RESULTS FROM, OR ARE ALLEGED TO HAVE RESULTED FROM, THIS ULTRASOUND, INCLUDING, BUT NOT LIMITED TO, THE FAILURE OF Tummy Vision Ultrasound Studio TO ACCURATLEY DETERMINE FETAL GENDER OR OTHER CHARACTERISTICS, AND ANY DAMAGES OR  INJURIES RESULTING FROM ULTRASOUND WHICH ARE NOT NOW KNOWN TO OCCUR.

      “I have carefully read this document and by signing at the bottom, acknowledge that I fully understand and agree to its contents.”

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  • Tummy Vision Covid19 Waiver

     

    1)     I agree to wear my mask at all times while in the Tummy Vision Studio, including the waiting room, even if no one else is around me. All children must wear a mask or face covering. I I need to remove my mask please leave the studio and re-enter with your mask on.

     

    2)     I will wear my mask properly at all times, fully covering my nose and mouth. This includes guests.

     

    3)     I understand the waiting room is remotely monitored at random times by a virtual receptionist to reduce the number of people in our studio. If you or your guests are seen not wearing a mask or improperly wearing one you may be called, sent a text and possibly asked to leave and your appointment will be cancelled.

     

    I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.


    I further acknowledge that Tummy Vision has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.


    I further acknowledge that Tummy Vision cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families.


    I voluntarily seek services provided by Tummy Vision and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.


    I attest that:


    * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.


    * I have not traveled internationally within the last 14 days.


    * I have not traveled to a highly impacted area within the United States of America in the last 14 days.


    * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.


    * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.


    * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.


    I hereby release and agree to hold Tummy Vision harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Tummy Vision. I understand that this release discharges Tummy Vision from any liability or claim that I, my heirs, or any personal representatives may have against the salon with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Tummy Vision. This liability waiver and release extends to the Studio together with all owners, partners, and employees.

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