Policies & Agreement

· Ultrasounds for fetal portraits are not medically necessary and are not covered by any health insurance plan or flexible spending account. The full charge of your appointment will be paid prior to the procedure.

· I understand that this 3D/4D sonogram does not replace any form of medical or diagnostic sonogram for any purpose, including but not limited to screening for genetic disorders, fetal anomalies, fetal growth assessment and fetal well-being.

· I represent and acknowledge that I am currently receiving prenatal care from a licensed medical provider and that FIRST LOOK is relying upon this representation in order to perform my 3D/4D sonogram.

· I understand that the 3D/4D sonogram is elective in nature and is for ENTERTAINMENT PURPOSES ONLY. I understand that FIRST LOOK cannot guarantee the accuracy of the 3D/4D images due to the unpredictable nature of my baby. 

· I understand that the images of my baby are not true depictions of how my child will appear after birth. Furthermore, I understand that there is a chance that during my visit my baby may not be optimally positioned (i.e. face down to my spine). 

· I understand that FIRST LOOK will try to accommodate me to the best of its ability and may ask me to return at a different time/day in such circumstances. I understand that all patients scan differently depending on gestational age, position, amount of amniotic fluid, placental location and maternal weight, and my 3D/4D image may not be similar to those I have seen elsewhere.

· If any illness, injury, or accident occurs which, in the sole judgment of the staff of FIRST LOOK, requires immediate medical attention, I give consent to terminate the 3D/4D sonogram, and I understand that I will be referred to my acting physician.

· In further consideration of FIRST LOOK performing an elective 3D/4D sonogram, I hereby assume all risks of personal injury to myself and my baby in any way associated with the 3D/4D sonogram. Three (3) and four (4) dimensional ultrasounds to obtain keepsake fetal portraits is an elective, not a medically necessary procedure.

· I understand that the US Food and Drug Administration and the American Institute of Ultrasound in Medicine (AIUM) are opposed to the use of medical technology for entertainment. According to the US Food and Drug Administration (FDA) there are no known bio-effects on the fetus. However, future research may disclose harmful or adverse effects that are presently unknown. 

· I hereby agree that FIRST LOOK, its members individually and its officers, agents and employees shall not be liable for any injuries or any damage to me or my baby, or be subject to any claim, demand, injury or damages, whatsoever, including without limitation, those damages from acts of passive or active negligence on the part of FIRST LOOK, its members individually and its officers, agents and employees. 

· I expressly acknowledge that FIRST LOOK will not review the 3D/4D sonogram for any purpose, and that it is not a diagnostic evaluation, nor is it intended to be diagnostic. 

· I hereby agree to expressly forever release, discharge and hold harmless FIRST LOOK, its members individually and its officers, agents, representatives, employees, officers and insurance companies from and against any and all claims, demands, injuries, damages, actions or causes of action, of whatsoever kind, which may arise from the performance of the 3D/4D ultrasound and/or any corresponding service provided by FIRST LOOK (including, but not limited to the failure of FIRST LOOK to identify, disclose, recognize, acknowledge, comment upon or notify me of any possible genetic disorders, fetal anomalies, fetal defects and/or any matter involving the health, safety and/or viability of the fetus).

· Further, I covenant not to sue FIRST LOOK, its members individually, or its officers, agents, representatives, employees, officers and insurance companies for any claims, demands, injuries, damages, actions or causes of action, of whatsoever kind, which may arise from the performance of the 3D/4D ultrasound and/or any corresponding service provided by FIRST LOOK (including, but not limited to the failure of FIRST LOOK to identify, disclose, recognize, acknowledge, comment upon or notify me of any possible genetic disorders, fetal anomalies, fetal defects and/or any matter involving the health, safety and/or viability of the fetus.