OB Ultrasound Terms & Conditions

PAYMENT & INSURANCE ACKNOWLEDGMENT

I acknowledge that the ultrasound services I am receiving from Clarity Ultrasound are provided on a self-pay basis. I accept full financial responsibility for all charges incurred and recognize that insurance claims will not be submitted on my behalf. I understand that payment is due in full at the time of service, and that Clarity Ultrasound does not accept insurance, offer billing, or provide reimbursement documentation for insurance submission. By signing below, I agree to these terms and acknowledge that I am responsible for all fees associated with the services provided.

VOLUNTARY PARTICIPATION

I am voluntarily participating in this ultrasound and understand that no guarantees are made regarding the visibility of the fetus, fetal gender, health outcomes, or completeness of findings.

LIMITATIONS AND LIABILITY

I release and hold harmless Clarity Ultrasound, its technicians, staff, and affiliates from any and all liability related to: 

  • Missed findings

  • Misinterpretation

  • Delayed diagnosis due to reliance on this limited scan

I understand that ultrasound results may not be 100% accurate and can vary due to fetal position, maternal body type, or other technical limitations. 

IMAGE QUALITY & REDO POLICY

There are many variables that affect the quality of our 2D/3D/4D/HD Ultrasound Experience. These may include, but are not limited to,

  • Proper water consumption for seven full days leading up to the appointment.

  • The gestational age of the baby.

  • The position and/or cooperation of the baby during the appointment.

  • Position of the Placenta

Clarity Ultrasound offers booking guidelines and tips for a successful session, but because of the factors listed above, we cannot guarantee image quality for your session.

If your baby is extra shy on the date of your appointment, and at your technician's discretion, you may be offered a free redo session to come back and try again during our redo hours. ALL REDO'S must be done within 2 weeks of your original appointment and must be done between the hours of 9am and 4pm Monday through Friday.

ULTRASOUND WAIVER OF LIABILITY

I, the undersigned, understand that the elective ultrasound services provided by Clarity Ultrasound are for fun and non-medical in nature. These services are intended solely for bonding experiences and are not a substitute for medical care or diagnostic procedures performed by a qualified healthcare provider.

I acknowledge that:

  1. The 3D/4D ultrasound service provided by Clarity Ultrasound is not intended to diagnose or detect any medical conditions or abnormalities.

  2. I am aware that the quality of the images can be affected by various factors, including the position of the baby, the amount of amniotic fluid, and the mother's body composition.

  3. I understand that while 3D/4D ultrasounds are considered safe, any questions or concerns about the procedure's safety should be discussed with my healthcare provider.

In consideration of the services rendered, I agree to release Clarity Ultrasound, its agents, affiliates, directors, and employees from any and all claims or causes of actions for injury, harm, or damage or other liability which results from, or alleged to have resulted from, this ultrasound, including, but not limited to, the failure of Clarity Ultrasound to accurately determine fetal gender or other characteristics, and any damages or injuries resulting from ultrasound which are not known to occur.

I agree to release, waive, discharge, and hold harmless Clarity Ultrasound, its employees, and representatives from any and all claims, liabilities, damages, and expenses arising from or related to my participation in the 3D/4D ultrasound session, including any issues related to the health or well-being of myself or my unborn child.

I understand that all images and recordings taken during the session are the property of Clarity Ultrasound. I consent to the use of my images for promotional purposes, including but not limited to advertising, social media, and website content.

I have read and understand the information above. By signing this form, I acknowledge that I am voluntarily participating in the elective ultrasound session and accept the terms outlined in this waiver. I understand to avoid incurring the 50% no-show fee by cancelling or rescheduling my appointment at least 24 hours prior.

As a further condition to receiving ultrasound services from Clarity Ultrasound, I hereby acknowledge, understand, and agree to the following statements:

  • This ultrasound is an elective procedure that I have voluntarily requested, and is not intended to take the place of a diagnostic ultrasound or any other test or treatment that has been or may be recommended by my healthcare provider. 

  • Because of its elective nature, this ultrasound is not covered by insurance. Therefore, payment is required at the time of the appointment. 

  • While qualified to provide such ultrasound services, the technician is not a doctor, nurse, or healthcare provider, and cannot interpret, diagnose, or offer medical conclusions regarding the ultrasound images produced. 

  • I understand that I am responsible for contacting my own healthcare provider if I have any questions concerning this ultrasound or any aspect of my pregnancy. 

  • I understand that factors beyond our control may also affect the ability to accurately determine the gender of the fetus, and that Clarity Ultrasound can provide no warranty or guarantee as to the accuracy of any such determination.

  • I 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. 

  • I understand that canceling or rescheduling my appointment with less than 24-hour notice will result in a charge of 50% of the scheduled service fee. 

  • I understand that failing to show up to my appointment without any notice (no-call/no-show) will result in a charge of 100% of the scheduled service fee.