I hearby authorize 3D to Your Door to perform an elective 2D, 3D, 4D ultrasound on my baby and me. I understand that this ultrasound is an elective procedure that i have voluntrarily requested. It is not preformed for any medical reason , or to diagnose any medical condition. I understand the service is only to provide photographic ultrasound images.
The quality of the images varies depending on the position and gestational age of the fetus as well as other factors such as placenta location, amount of amniotic fluid and expectant mother’s size and weight. In the event that the images are not to my satisfaction or desired quality, I agree that 3D to Your Door does not guarantee to provide perfect image quality.
No refunds will be given for any reason.
Because this is a non-diagnostic sonogram, the expectant mother must be under the care of an obstetrician, and have had a prior diagnostic sonogram to screen for fetal anomalies prior to having this scan.
I will address all medical questions with my physician. I hereby waive 3D to Your Door employees from any and all claims or causes of actions for injury, harm, damage or other liability which result from, or are alleged to have resulted from this ultrasound, including, but not limited to, the failure of a 3D to Your Door ultrasound to accurately determine fetal gender or other characteristics.
As evidenced by your signature below, you understand that we cannot guarantee or provide warranty as to the accuracy of gender of the fetus. You further understand that while ultrasound is believed to have no harmful effect on the mother or the fetus, future research may disclose harmful or adverse effects that are presently unknown.
** I have carefully read this document and by signing at the bottom, acknowledge that I fully understand and agree to its