Client Information & Waiver Form Agreement


Your Name
Contact Information
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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.

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 for the sole purpose of obtaining images. 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.

Please confirm you understand the above;

Your Health: I am currently in good health and there is no reason I should not attend my scan today

Picture Quality: 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.

Prenatal Care: I understand that this ultrasound is not to be used to replace medical care during my pregnancy. I understand that the scan follows they 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.

Photo Release: I give permission for P.A.S to post or use any photos or recorded data for advertisement purposes. I understand no names will be posted or used with the images. Optional

No Professional Negligence Claims: I am purchasing services and products for keepsake, non-medical purposes. I agree that I have no right to recourse against Professional Antenatal Services Ltd 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. I understand that my scan will follow Care Quality Commission / NICE Guideline recommendations for length of scan and frequency of ultrasound sound waves, and that no detrimental effects have been found in 40 years of studies. 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. I agree that I shall have no right whatsoever to file any lawsuit or institute any other action or legal proceedings of any type arising out of or in any way related to the services purchased.

I have read and understood the above



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