• Volunteer Sign Up & Consent Form

    McKenzie River Gynecology 2026

  • Thank you for volunteering to be a model for our ultrasound training course. The
    women's health providers in this course are working toward providing better care with ultrasound used at the bedside instead of sending patients to a separate office. Some things that are important for you to understand regarding your time with us:


    1. This is not a full diagnostic scan. This does not replace any ultrasound scan that your midwife or doctor orders for you.


    2. The goal is focused entirely on teaching the course participants.

    3. For the goal of having information to evaluate the scanning, we may ask for some
    basic history of your health, the dating of this pregnancy and any complications that
    may be involved with your pregnancy. All information will be kept confidential among
    the scanning team.


    4. You will be included in the teaching today to tell the scanners if they are pressing toohard or causing any discomfort. We will also share with you any information that is a part of the teaching.


    5. We will not be focusing on fetal anatomy to such an extent to identify any
    abnormalities of the baby. So, because we do not see a problem, does not mean
    everything is fine. That is why you need to get any ultrasound exams done as ordered by your provider. If there is any suspicion of a concern about the normalcy of the study, the information will be shared with your provider to be certain that you get any care that is indicated.


    6. If possible, we will take pictures for you to take home, but this will be a limited part of our time together.


    7. If you feel uncomfortable about any of this information or at any time during the
    scanning time, please let us know and you may end the examination.

     

     

    Location:

    McKenzie River Gynecology

    1755 Coburg Road Unit 503 Eugene, OR, 97401

     

     

    Important Scheduling Information:

    If a time slot is showing as available, you are signing up for that open appointment!

    You can choose one time slot each day, no more than one a day. If a slot is available and you submit your registration for that time, that is the appointment we will confirm for you. You will receive a confirmation email within 24 business hours.

    Please note that weekends are not included in this timeframe. Since you are selecting an available time slot, the confirmation email will simply verify the appointment you chose, so please plan to attend that scheduled time. Your confirmation email will include all of your date and time details.

    Thank you so much for volunteering. We truly appreciate your help.

  • Format: (000) 000-0000.

  • Please make sure that you fit the criteria of the time slot you are selecting. 

  • GYN or First Trimester (Up to 13 weeks) 8:00 AM -9:00 AM
  • Second Trimester (14-27 weeks)- 9:00-10:00AM
  • GYN or First Trimester (Up to 13 weeks) 10:00 AM-11:00 AM
  • Second Trimester (14-27 weeks) 11:00 AM AM-12:00 PM
  • Third Trimester (28+ weeks) 1:00- 2:00 PM
  • GYN or First Trimester (Up to 13 weeks) 2:00-3:00PM
  • Third Trimester (28+ weeks) 3:00-4:00 PM
  • GYN or First Trimester (Up to 13 weeks) 4:00-5:00 PM
  • WAITLIST: If we don't currently have appointments available for your trimester, or if none of the available appointment times work with your schedule, please join our waitlist. You can sign up for one or both event days.We confirm all volunteer appointments approximately two weeks before the event and again 2–3 days beforehand. If someone needs to cancel, we immediately begin contacting volunteers on the waitlist to fill those openings.Thank you!
  • If this is a GYN visit do you currently have an IUD?*
  • Where did you hear about this event?*

  • I understand the above statements and am volunteering willingly to be a model for this ultrasound teaching course.

    Thank you very much for sharing your time with us for the purpose of teaching your providers to be better prepared to give the best care to you and others. We are very grateful for your assistance.

    - The students and instructors of this course.

  • Photo Release Form

  • I hereby grant and authorize Ultrasound for Women's Health Providers the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements,fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration.

    This authorization extends to all languages, media, formats and markets now known or later discovered. This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing. I waive the right to inspect or approve any finished product in which my likeness appears, including written or electronic copy.


    I agree that I have not been compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the photograph. I understand and agree that these materials shall become the property of Ultrasound for Women's Health Providers and will not be returned.

    I hereby hold harmless and release Ultrasound for Women's Health Providers from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

    I understand the above and agree to the terms of the photo release form

  • Important Scheduling Information:

    If a time slot is showing as available, you are signing up for that open appointment!

    You can choose one time slot each day, no more than one a day. If a slot is available and you submit your registration for that time, that is the appointment we will confirm for you. You will receive a confirmation email within 24 business hours.

    Please note that weekends are not included in this timeframe. Since you are selecting an available time slot, the confirmation email will simply verify the appointment you chose, so please plan to attend that scheduled time. Your confirmation email will include all of your date and time details.

    Thank you so much for volunteering. We truly appreciate your help.

     

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