Secret Stork Ultrasound LLC offers elective 2D/3D/4D prenatal ultrasound for an entertainment keepsake and to provide a positive bonding experience for mother, family members, and friends with the unborn child. This entertainment ultrasound session will not provide any assumptions, diagnosis, or medical input of any kind and is not intended to take the place of a diagnostic ultrasound or any other medical procedure(s) recommended by your physician or health care provider. I acknowledge the following:
1. I am under the care of a physician or health care provider for the medical diagnosis, input, and recommendations relating to my pregnancy.
2. I certify I am obtaining this 2D/3D/4D ultrasound for entertainment only and I am not obtaining this ultrasound as a replacement for, or in lieu of, standard medical care.
3. I have undergone a medical diagnostic ultrasound prescribed by my health care provider in regards to this pregnancy. My health care provider ultimately will confirm my due date, screen for fetal abnormalities, and/or any abnormalities related to my pregnancy.
As a condition of receiving an entertainment ultrasound from Secret Stork Ultrasound LLC, I, hereby acknowledge, understand, and agree to the following statements:
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This ultrasound is an elective, non-medical procedure that I have voluntarily requested.
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The technician performing the ultrasound is not a doctor and cannot interpret diagnostic medical conditions, or otherwise offer medical conclusions regarding the images obtained during my ultrasound.
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I understand that the obtained images will not be reviewed by a radiologist or physician.
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I agree that I have no right of recourse against Secret Stork Ultrasound LLC for any medical malpractice, professional negligence or medically related claims arising out of the use of this keepsake service.
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The ultrasound session(s) is/are intended for entertainment purposes only to view fetal movements. The technician will make no attempt to provide a medically inclusive ultrasound or confirm fetal well-being.
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I understand that I am responsible for contacting my health care provider if any questions arise concerning any issues relating to this ultrasound session or any aspect of my pregnancy.
You understand that while Secret Stork Ultrasound LLC will make every effort to capture high quality images of your baby/babies, we cannot guarantee the cooperation nor the position of the baby/babies. Every pregnancy scans differently, depending on the gestational age, position, amount of fluid, placental location and mother’s body habitus. However, we promise to make every effort to obtain the best images possible per session. If we are unable to obtain quality images of your baby/babies, we have still provided the service of the 3D/4D Ultrasound thus we will not provide a refund if you are unhappy with the results. If warranted, we will however offer a return session at a discounted rate on a case by case basis. Please understand that factors beyond our control may also affect the ability to accurately determine the gender of the fetus, and that Secret Stork Ultrasound LLC can provide no warranty or guarantee as to the accuracy of any such determination. Secret Stork Ultrasound LLC reserves the right to publish, distribute and market all intellectual property including any images/video clips obtained during your ultrasound session. Secret Stork Ultrasound LLC will take appropriate and reasonable actions whenever possible to anonymize such images/content in order to remove and or disguise relevant identifying details and information.
AS EVIDENCE BY YOUR SIGNATURE BELOW AND IN CONSIDERATION OF THE SERVICES RENDERED, YOU AGREE TO RELEASE Secret Stork Ultrasound LLC, 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 Secret Stork Ultrasound LLC TO ACCURATELY DETERMINE FETAL GENDER OR OTHER CHARACTERISTICS, AND ANY DAMAGES OR INJURIES RESULTING FROM ULTRASOUND WHICH ARE NOT NOW KNOWN TO OCCUR.
