|
Women’s Health Professionals, LLC offers two distinct packages from which to choose:
Baby Face:
Includes 4D sonogram recorded on your VHS tape, two 31/2 x 5 in. color photographs and two 21/2 x 31/2 in. black and white images on thermal sonogram paper.
Price: $150
Baby Face Deluxe:
Includes the Baby Face package, plus digital still shots and digital video recorded to a CD-ROM (CD included). This allows captured images and videos to be viewed, printed, and e-mailed from your personal computer.
Price: $175
Payment Agreement and Consent
I understand that the 4D sonogram procedure is being provided at my request and that my insurance company does not cover the associated cost. I further understand that the study is not for diagnostic purposes and is not being used for medical decision making. I understand that the quality of the sonogram image is dependent on my baby’s position, my baby’s movement, as well as my size and weight. I understand that I will be offered a single return visit at no additional charge if the images are unsatisfactory, however, no refunds will be made.
Print, sign and return this form to our office.
Signed: _______________________________
Date: _________________
|
|
