388 W 80th PL, Merrillville, IN, 46410 Phone: (219) 746-0915 Fax: (219) 370-0508
Print a copy of the consent form here
Elective 3D, 4D and HD Live (5D) Ultrasound
Baby Gender Plus is pleased to offer 3D, 4D, and HD Live (5D), ultrasounds as an elective service for our customers who would like a keepsake fetal portrait and DVD or flash drive with still images. 3D ultrasounds show three-dimensional pictures of your baby, and 4D gives the added dimension of time, allowing you to see your baby’s movements. HD live (5D) gives a realistic skin tone feature to your baby. We also offer gender scans, which allows you the opportunity to get a sneak peek of the sex of your baby. Once your ultrasound is scheduled, it may be helpful to drink plenty of water for optimal visualization. The ultrasound image may vary depending on customer size and weight, the baby’s position, the location of the placenta and amount of amniotic fluid.
Baby Gender Plus ultrasounds for fetal portraits are not medically necessary and are not covered by any health insurance plan or flexible spending account. There is a $25 non-refundable fee that is required to book your appointment. The balance is due the day of your exam.
- · 3D, 4D and HD live (5D) to obtain a keepsake fetal portrait is an elective, non-medically necessary exam. According to the US Food and Drug Administration (FDA) there is no known bio-effects on the fetus. However, future research may disclose harmful or adverse effects that are presently unknown.
- · No fetal growth measurements or anatomical surveys will be performed or documented as part of the keepsake fetal portrait session. Nevertheless, fetal anomalies discovered during the session will be reported to your physician for prenatal standards of care.
- · The required gestational age for baby gender discovery is a minimum of 16 weeks and fetal portraits are between 28 to 32 weeks because amniotic fluid levels are optimal and the fetus has adequate body fat and tissue.
- · Our exams are performed by experienced and/or Registered Ultrasound Technicians. Physicians do not read the exam and there is not a formal report.
☐ By checking this box, I hereby give permission for Baby Gender Plus to use my photographic likeness in all forms of media for advertising, trade and any other lawful purposes.
I hereby waive Baby Gender Plus staff from any and all claims or causes of action from, or alleged to have resulted from this ultrasound, including, but not limited to, the failure to accurately determine fetal gender or other characteristics.
I have read, fully understand and have received a copy of the above information. I have had the opportunity to discuss my questions and concerns with my obstetrician. I choose to proceed with an elective ultrasound to obtain fetal portraits.
Customer’s Printed Name Customer’s Signature Date
Witness Date and Time
No videos or pictures are allowed by customer or customer’s guests during the fetal portrait session. Our assigned partner “Scarlett Velvet Photography” will provide this service, if included with customer’s package.