Anticipation Check-In Form

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Registration and Authorization of Services
(Puedes usar Google Translate.)

Email *

Name *

Phone number *

Your date of birth *

Due date *

Doctor's name and phone number *

Your Instagram Name (optional)

How did you hear about us *

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Family/ Friend

Facebook

Previous vist

Other:

If you found us online what did you search

By checking here, you acknowledge and fully understand and agree to this statement. *

Anticipation Ultrasound Studio understands the importance of proper prenatal care for both the expectant mother and the baby. Therefore, in order to provide our clients with an elective ultrasound, we require that you read and agree to the following: 1) The client understands that elective ultrasound imaging services are not medical procedures and are not offered as a medical treatment or diagnosis. 2) The client understands that no guarantee can be made as to the quality of the images obtained due to circumstances beyond our control. At our discretion, we may offer a free session in the event that acceptable images are not obtained. 3) We do not refund payment for any services performed. 4) Anticipation Ultrasound Studio may use images obtained during the session for marketing purposes.

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