Waiver and Release

• I understand that this ultrasound service is nondiagnostic and does not take the place of a
• medical ultrasound.
• I understand that I am purchasing images, imaging services, and products from Look At Me 4D
  Imaging for entertainment purposes only. Look At Me 4D Imaging is not a licensed medical
  professional and is not providing any medical care. I agree I have no right to recourse against
  Look At Me 4D Imaging in any medical malpractice, professional negligence, or any medical
  claim related to my pregnancy or the birth of my child, including error in sex determination.
  I am currently receiving care from a health care professional.
• I acknowledge the images created by Look At Me 4D Imaging have little or no diagnostic value.
  I understand no diagnosis will be made during this ultrasound. If I have any concerns about my
  pregnancy, I will not rely on Look At Me 4D Imaging for any medical advice.
• I understand there is an inherent risk in any activity while pregnant including this ultrasound
  session. I acknowledge it is my responsibility to inform myself of these risks before pursuing
  these ultrasound services. I assume all risk of harm or injury to me or my fetus resulting from the
  services provided by Look At Me 4D Imaging.
• I hereby release and forever discharge Look At Me 4D Imaging and their employees from all
  liability, claims, and demands, actions and causes of action, and other actions and liabilities, of
  any nature whatsoever, that I or my baby have to arise out of or in any way related to my visit to
  Look At Me 4D Imaging. I agree that I have no right to file any lawsuit or institute any other
  action or legal proceedings of any type arising out of or in any way related to my visit to Look At
  Me 4D Imaging. As defined in this document, Look At Me 4D Imaging shall include its owners,
  officers, agents, employees, attorneys, and affiliated related entities.
• I understand this waiver and release is a binding legal document that affects my legal rights.
  This document also binds my spouse, children, heirs, representatives, distributes, guardians,
  and assigns.
• I acknowledge, in rare circumstances, Look At Me 4D Imaging may wish to contact my medical
  care provider. I give my permission for Look At Me 4D Imaging to contact my medical provider I
  listed on this form.
• I give Look At Me 4D Imaging permission to reproduce, post, or use any images or recorded
  data, without further compensation, for advertisement and promotional purposes.
• I am aware and prepared for certain circumstances that may prevent Look At Me 4D Imaging
  from obtaining quality Images. These circumstances may include any one or combination of the
  following: fetal position, amniotic fluid, location of the placenta, location of extremities, maternal
  obesity. If the Look At Me 4D Imaging ultrasound technologist is not satisfied with the
  cooperation of the baby and the images obtained, Look At Me 4D Imaging may offer a free
  repeat session.

By signing I acknowledge that I have read and I understand all of the above.