WAIVER OF LIABILITY

Bitsy & Me 4D Ultrasound 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, Bitsy & Me 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; and (ii) notify your current physician or health care provider regarding the ultrasound you receive from Bitsy & Me.

 

We request that you present to Bitsy & Me an acknowledgement of receipt of this notice, signed by your physician or health provider, prior to performance of the ultrasound. In the event you are unable to notify your physician or health provider prior to performance of the ultrasound, you assume sole responsibility for notifying him or her as soon as practical following performance of the ultrasound.

 

As a further condition to receiving ultrasound services from Bitsy & Me, you hereby acknowledge, understand and agree to the following statements:
 

 

 

 




 

 






 

 

 

 


 

 

As evidenced by your agreement below, you understand that factors beyond our control may also affect the ability to accurately determine the gender of the fetus, and that Bitsy & Me 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 CONSIDERATION OF THE SERVICES RENDERED, YOU AGREE TO RELEASE BITSY & ME 4D ULTRASOUND, 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 A BITSY & ME 4D ULTRASOUND TO ACCURATELY DETERMINE FETAL GENDER OR OTHER CHARACTERISTICS, AND ANY DAMAGES OR INJURIES RESULTING FROM ULTRASOUND WHICH ARE NOT NOW KNOWN TO OCCUR.

Thank you, please return to your booking screen