Mother Nurture 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, Mother Nurture 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 Mother Nurture. We request that you present to Mother Nurture 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 Mother Nurture, you hereby acknowledge, understand and agree to the following statements:
– This ultrasound: (i) is an elective procedure that I have voluntarily requested, and (ii) 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 your healthcare provider.
– Because of its elective nature, this ultrasound is generally not covered by insurance. Therefore, out of pocket payment is required. Payment type can be cash or card. We charge a $3 transaction fee if you use a card for payment. There is no additional fee for paying cash.
– The technician who performs this ultrasound, while qualified to provide such ultrasound services, is not a doctor, nurse or healthcare provider, and cannot interpret, diagnose medical conditions from, or otherwise offer medical conclusions regarding the images produced.
– As used by Mother Nurture, this ultrasound is intended to provide enhanced images for the purpose of viewing fetal movement in utero. The technician will make no attempt to guarantee a medically inclusive ultrasound or fetal well-being.
– You understand that you are responsible for contacting your own healthcare provider if you have any questions concerning this ultrasound or any other aspect of your pregnancy.
– You understand that the quality of the ultrasound and the DVD, USB, or other audio visual media, depends upon many factors including; body tissue content, developmental stage and fetal position.
– You understand that Mother Nurture does not guarantee the quality of the DVD, USB, or other audio visual media, or the ability to visualize any characteristics of the fetus.
– You understand that publication, presentation or distribution of any video taken during the ultrasound session, not provided by Mother Nurture, is strictly prohibited.
– You give permission for Mother Nurture Ultrasound to record audio in the room during the ultrasound appointment. It is your responsibility to inform all guests attending that their audio is being recorded while in the room.
– You give permission for Mother Nurture to use your child’s 3D/4D ultrasound photographs in its print collateral, video/web and magazine advertising, without payment or other consideration. You understand and agree that the photos being used are for print and display primarily in our office, but these photos and DVD may also be used at different venues such as local live events and used for local advertising.
– You understand that while we make every effort to capture a good image of your baby, we cannot guarantee the cooperation nor the position of the baby. Sometimes if the baby’s position is face down, i.e., towards your spine, it may be difficult to see the baby’s face. There are several factors that affect the quality of imaging; the baby’s gestational age, position baby’s body and position of hands and feet, amount of amniotic fluid, placental location, location of umbilical cord, and mother’s body habitus. In situations where we feel we can get better imaging on another day, we will offer a free bring back visit. If it is a situation where we feel a free bring back would not yield better results, one will not be offered and there is no refund. The bring back visits are only scheduled on Wednesdays and Thursdays between 9:30 AM and 3:30 PM. You will not be refunded or rescheduled if you fail to show up for your bring back appointment.
– We cannot guarantee gender determination on women who are only 13 weeks and over 200 pounds. If you are over 200 pounds, you must wait until 14-15 weeks.
– There will be no refund or bring back if you come in for a gender determination ultrasound and you are not far enough along to see the baby’s gender. It is the responsibility of the client to know the due date and accuracy of it.
– There will be no refund or bring back offered if you are less than 8 weeks and we cannot see the baby. It is the responsibility of the client to know the due date and accuracy of it. We highly suggest that if you come in for an early ultrasound you have either already had an ultrasound with your doctor, or are extremely confident in your due date based off your last menstrual period.
– We promise to make every effort to obtain the best images. If we are unable to get a good image of your baby, we have still provided the service of the 3D/4D Ultrasound thus we will not provide a refund if you are unhappy with the results. By scheduling an appointment you are accepting our terms and conditions, you understand that factors beyond our control may also affect the ability to accurately determine the gender of the fetus, and that Mother Nurture 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.
– You agree that you have read and reviewed the details of the package you purchased and fully understand what is included in that package.
– You agree to refrain from posting any negative review or complaint, on social media, google, yelp, or other public websites. All concerns about your experience and the services you received must be made within fourteen (14) days from the day the service was received. Complaints must be addressed to the owner, Sara Gamache in person, over the phone, or through email. A negative complaint entails anything less than a 5 star review with comments that can be perceived by the average person as derogatory, defamatory, or critical to the services or staff. Failure to remove any such review within 24 hours can result in legal action against you.
– If you are using the Sneak Peek blood draw services which are hosted within the Mother Nurture Ultrasound facility you acknowledge that Mother Nurture Ultrasound is only acting as a 3rd party and is in no way legally affiliated to Sneak Peek. After you have received the blood draw, all communications regarding the service, including complaints, status of results, and questions need to be directed to Sneak Peek. You agree to refrain from naming Mother Nurture Ultrasound in any negative review or complaint, on social media, google, yelp, or other public websites in regards to the Sneak Peek service.
– If you used the Sneak Peek services and the blood test comes back inconclusive you will be given the option to schedule a redraw 1-2 weeks later (depending on how far along you were at the first appointment) or receive a full refund. Redraws are only performed on Wednesdays and Thursdays between 9:30 AM and 3:30 PM. If the second test comes back inconclusive there is no refund or third draw scheduled.
IN CONSIDERATION OF THE SERVICES RENDERED, YOU AGREE TO RELEASE MOTHER NURTURE, 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 MOTHER NURTURE ULTRASOUND TO ACCURATELY DETERMINE FETAL GENDER OR OTHER CHARACTERISTICS, AND ANY DAMAGES OR INJURIES RESULTING FROM ULTRASOUND WHICH ARE NOT NOW KNOWN TO OCCUR. “I have carefully read this document and by checking the box on the appointment form online, I acknowledge that I fully understand and agree to its contents.”
Official contact information:
803 39th Ave SW, Suite D
Puyallup, WA 98373
Phone number: 253-777-6263 | Email: info@mothernurture4d.com | Owner: Sara Gamache | Sara Gamache, Co (DBA Mother Nurture Ultrasound)
