ULTRASOUND PACKAGES

Sneak Peek Imaging LLC

6411 W Nob Hill Blvd

Yakima, WA 98908

Sneak Peek Imaging LLC 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, Sneak

Peek Imaging LLC 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 Sneak

Peek Imaging LLC. 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 Sneak Peek Imaging LLC, 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, advance payment

is required.

– 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 Sneak Peek Imaging LLC, 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, or other audio visual media, depends upon many

factors including; body tissue content, developmental stage and fetal position. You understand that Sneak Peek

Imaging LLC does not guarantee the quality of the DVD, 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 Sneak Peek Imaging LLC, is strictly prohibited.

– 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. In this case, a one-time complimentary rescan will be scheduled. Every baby

scans differently, depending on the gestational age, position, amount of fluid, placental location and mother’s body

habitus. However, 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. As evidenced by your signature below, you understand that factors beyond our control may

also affect the ability to accurately determine the gender of the fetus, and that Sneak Peek Imaging LLC 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.

IN CONSIDERATION OF THE SERVICES RENDERED, YOU AGREE TO RELEASE Sneak Peek Imaging LLC, 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 Sneak

Peek Imaging LLC TO ACCURATELY DETERMINE FETAL GENDER OR OTHER CHARACTERISTICS, AND ANY

DAMAGES OR INJURIES RESULTING FROM ULTRASOUND WHICH ARE NOT NOW KNOWN TO OCCUR.