CONSENT TO NON-MEDICAL ELECTIVE ULTRASOUND

I consent to First Flutters, LLC conducting an elective ultrasound exam (Ultrasound) strictly and solely for entertainment purposes. I acknowledge and agree the Ultrasound is not being considered or conducted for medical or diagnostic purposes, nor will any medical information be obtained, discussed, or provided to me through Ultrasound. All information obtained by this Ultrasound through either direct viewing of the video monitor, or any photographs, DVD, or other media is strictly and exclusively for entertainment purposes and not in any manner for medical or diagnostic purposes. I also consent to First Flutters LLC using any images and/or videos obtained during the ultrasound scans on all social media and affiliated websites.

I agree that First Flutters, LLC, its employees, owners, agents, affiliates, Sonographers, (collectively First Flutters, LLC) have no obligation whatsoever to perform any medical procedure or examination or report or provide any diagnostic medical diagnosis or medical information during or as a result of the Ultrasound. I agree that I shall rely solely on my personal healthcare physicians/providers for any medical information related to the Ultrasound and agree that I shall consult with my physician/provider regarding any medical information that could be obtained, if any, from the Ultrasound.

I understand that there is no current evidence that ultrasound causes any harm to the fetus or mother, birth defects, genetic disorders, miscarriages, premature labor, bleeding, pregnancy complications, or any other known medical complications to the mother or fetus. I understand that Ultrasound does NOT use x-ray, radiation, or any other radiation energy. I agree there is a possibility that an unknown birth defect or other abnormality may presently exist, and First Flutters, LLC is not responsible for the diagnosis of such an existing condition.

I agree that First Flutters, LLC shall have no responsibility to detect, report, or diagnose any defect or abnormalities observed during the Ultrasound, as First Flutters, LLC does not provide any medical services. I hereby release and agree to hold harmless from any claims, including emotional, mental, or physical distress, which may arise in connection with the Ultrasound or information discovered or discoverable from the Ultrasound.

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I understand that certain conditions may prevent obtaining clear imaging, including fetal position, placenta covering fetal face, maternal weight, etc. If it is clear the Ultrasound will not be of good imaging quality due to these reasons, the client has the option of rescheduling one time, at no charge, courtesy re-scan.

CANCELLATION POLICY

Clients may cancel or reschedule their appointment with a full refund if notice is provided at least twenty-four (24) hours prior to the scheduled appointment time. Cancellations made less than twenty-four (24) hours before the appointment, as well as missed appointments (no-shows), are non-refundable. By booking an appointment, clients acknowledge and agree to this cancellation policy.

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FINANCIAL RESPONSIBILITY

Payment for all services provided in connection with the Ultrasound are the sole responsibility of the Client and are due in full at the time services are rendered. Client agrees that because the Ultrasound is not being provided for medical purposes, the cost for the service is not covered, billed, or reimbursed by health insurance.