Release and Waiver form – Telly Tummy

I, the Client hereby consent to have an elective 4D ultrasound performed by Telly-Tummy (Pty) Ltd

I acknowledge that I am under the care of a doctor/physician/obstetrician for medical diagnosis and recommendations regarding and related to my pregnancy. I fully recognize, understand and accept that this ultrasound is only for entertainment purposes and does NOT replace any routine clinical appointments, procedures, doctors or midwife appointments or routine checks.

Furthermore I acknowledge, understand and agree to all of the following statements:

• This is an elective non-diagnostic 4D prenatal ultrasound that I requested. It is ONLY for keepsake, and seeks to create a positive bond between family, friends and the unborn baby.
• The technician performing the ultrasound is NOT qualified to interpret medical conditions or offer medical advice.
• I am responsible to contact my physician or health care provider if any concerns or questions arise concerning my pregnancy during this ultrasound session.
• I understand and accept that this ultrasound is NOT intended to do or perform any diagnostics of any nature, or to detect any obstetric problems and/or fetal anomalies.
• Neither is it performed to give any medical input, reveal gender, date the expected time of delivery nor provide any fetal measurements.
• I realise and accept that an optimal view and therefore favourable image of my baby is not guaranteed due to several factors outside of the ultrasound technician’s control, such as the position of the baby in the womb, the amount of amniotic fluid, the stage of fetal development and etc.
• I understand that Telly-Tummy has the right to anonymously use any images and/or videos taken during my ultrasound session for marketing and educational purposes, after any names, dates and times have been removed.
• In consideration of the ultrasound services provided, I release Telly-Tummy and its employees from any and all claims or cause of action for injury, harm, loss, damage or other liability, whether caused by negligence of the employee or that result from the ultrasound.
• Furthermore, I understand that while at the time of the ultrasound session Telly-Tummy it is believed that ultrasounds are harmless and have no proven adverse effects to mother or fetus – further research may reveal adverse effects currently not known.
• I hereby agree that I have carefully read and understood this release and waiver of Liability.