Waiver form

Waiver form


Please read and fill out the waiver form below prior to your appointment.

Waiver declaration


I have read and understand this waiver:

Important Please read...


All scan packages provided by MYM have the primary purpose of maintaining and monitoring the health and wellbeing for mother and baby. Once the scan has checked the viability of your pregnancy and the readings taken to enable preparation of your wellbeing report, we allow you to listen to your baby heart beat for bonding and reassurance purposes. We are happy to then provide gender, 4D images and other such services in addition to and as part of our scanning packages. You will be provided with the wellbeing report which will summarise the following for the purpose of monitoring the health and identifying the development of baby including heart rate, movement and key fetal biometry measurements.


A simple guide to what is possible:


Picture quality: An ultrasound scan can only show what is actually happening with your baby. We cannot make your baby change position or perform for a scan picture. Every scan is performed in the same way, with the same equipment. The only thing that effects the quality of the images is you and your baby. The sonographer will explain what is possible and on request can explain why the images may be unclear - please DO ASK. Some scan images are clearer than others and this is not in the control of the sonographer.

I understand picture quality is dependent on many factors. I understand that Professional Antenatal Services Ltd are not always able to obtain pictures of every baby. I understand no refunds are available if unable to obtain pictures or gender.


Our scans: All our ultrasound scans have limitations in what can be assessed and diagnosed dependant on many factors. Your reassurance scan will date your pregnancy, confirm a heartbeat is present and confirm the location of your pregnancy providing your pregnancy is at least 8 weeks gestation at the time of the scan.


Gender Determination: No gender determination via ultrasound is guaranteed to be 100% correct. Gender determination is based on the visual clues observed. The earlier gender determination is requested the greater the chance of incorrect determination. You accept full responsibility in this regard.


Consent: What will happen during my scan? The NHS website (www.NHS.uk) explain the process as follows: You lie on your back and some lubricating gel is put on your abdomen. A small device is then passed backwards and forwards over your skin, and high-frequency sound is beamed through your abdomen into the womb. The sound is reflected back and creates a picture, which is shown on a screen.

The procedure has been explained to me and I give consent for an ultrasound scan to be performed for the purpose of monitoring my baby's wellbeing and thereafter obtaining images if I wish. I understand that if at any time I wish the scan to cease, I must inform the sonographer who will comply immediately. I understand the recommendation that I have a chaperone attend during my scan, but I can opt to attend alone.


Your Health:

I confirm that I am currently in good health and there is no reason I should not attend my scan today.


Antenatal Care:

I understand that this ultrasound is to be used to supplement but not to replace NHS medical care during my pregnancy. We encourage you to take your wellbeing report received as part of this ultrasound to your NHS appointments. I understand that the scan follows the National Institute of Clinical Excellence guidelines for frequency (sound waves) and length of scan - which has found no detrimental effects in 40 years of case studies, but the British Medical Ultrasound Society do not recommend ultrasound for non medical purposes.


No Professional Negligence Claims: I am purchasing services and products primarily for viability and reassurance to monitor my baby's wellbeing at the time of the scan. I understand that my medical care is provided by the NHS and any medical concerns must be addressed by the NHS as our scans are limited in their scope due to not being a provider of vaginal scans. I agree that I have no right to recourse against Professional Antenatal Services Ltd trading as MYM in any medical malpractice, professional negligence or any medical related claim arising out of or in any way related to my pregnancy or the birth of my child. This includes any claim for error in gender determination. 


The Small Print.

We have tried as best we can to ensure this document is written in plain english. If you would like any aspect of it explaining further, please do ask - we are happy to help!


Waiver and Release of Claims: I hereby waive, release, acquit and forever discharge Professional Antenatal Services Limited from any and all claims, expenses, demands, costs, causes of action, and other actions and liabilities, of any nature whatsoever, whether known or unknown, whether in law or equity, that I or my baby may have arising out of or in any way related to the services provided.


Permissions:

I give permission for MYM to post or use any photos or recorded data for advertisement purposes. I understand no names will be posted or used with the images. I authorise MYM to contact the NHS and provide information obtained during my scan to the NHS if the health of mother or baby is of any concern.


Please bring your pregnancy notes with you to your appointment.


If you choose to purchase images/movies transfers please remember these are downloadable for 21 days following your appointment, sadly we cannot be responsible if these are not downloaded before expiry.

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