By checking this box I agree that this pregnancy is being supervised by a certified physician or midwife.*

1. NATURE AND PURPOSE OF SERVICE

   By checking this box I understand that Baby Bear 3D4D Ultrasound LLC provides elective fetal ultrasound experiences for keepsake, bonding, viewing and entertainment purposes only. The service is not a substitute for prenatal care, diagnostic imaging, screening, medical evaluation, treatment, or advice from a physician, midwife or other qualified healthcare provider.

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2. CALIFORNIA REQUIRED KEEPSAKE DISCLOSURE California Health & Safety Code §123620 disclosure: “The federal Food and Drug Administration has determined that the use of medical ultrasound equipment for other than medical purposes, or without a physician’s prescription, is an unapproved use.”

   By checking this box, I acknowledge that I received and read this disclosure before the ultrasound procedure.

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Ultrasound uses non-ionizing sound waves to create images. When used appropriately, ultrasound is generally considered safe. As with any ultrasound procedure, energy exposure can produce tissue heating, and certain conditions can contribute to cavitation.

By checking this box, I acknowledge that I received and read this disclosure before the ultrasound procedure.*

3. NO DIAGNOSIS OR MEDICAL INTERPRETATION

By checking this box, I agree that I understand Baby Bear 3D4D Ultrasound LLC does not diagnose, screen for, or rule out medical conditions or fetal abnormalities. I understand that Baby Bear 3D4D Ultrasound LLC does not provide prenatal medical care and does not replace appointments, testing, or recommendations from a healthcare provider.*

By checking this box, I understand that images or observations made during an elective session should not be relied upon to determine fetal health, growth, anatomy, pregnancy viability, or any other medical condition. I agree not to rely on Baby Bear 3D4D Ultrasound LLC's service as a medical examination or as confirmation that my pregnancy is progressing normally. If I have a medical concern or question about the pregnancy, I understand that I should contact the appropriate medical provider.*

4. VOLUNTARY CONSENT

By checking this box, I understand that I have a right to have an opportunity to ask questions about the elective ultrasound experience and understand its purpose and limitations. I am choosing this service voluntarily and understand that I may decline or stop the session at any time. I understand that no medical diagnosis, treatment, or medical advice will be provided as part of this service.*

5. IMAGING, QUALITY & SESSION LIMITATIONS

By checking this box, I understand that ultrasound image quality varies based on gestational age, fetal position, movement, maternal anatomy, amniotic fluid, placental location, equipment, and other factors. I understand that Baby Bear 3D4D Ultrasound LLC cannot guarantee that a particular image, view, fetal position, or gender determination will be obtained.*

By checking this box, I understand that a session may be shortened, modified, paused, or stopped when reasonably necessary for safety, equipment limitations, client comfort, or other circumstances.*

6. GENDER DETERMINATION (IF PURCHASED)

If I request gender information, I understand that any gender determination offered by Baby Bear 3D4D Ultrasound LLC is an elective, non-diagnostic observation based on the ultrasound appearance at the time of the session. By checking this box, I understand that it is not guaranteed to be accurate and should not be relied upon for medical or legal purposes.*

7. RISKS & RESPONSIBILITIES

I understand that elective ultrasound is not medically necessary for my pregnancy. I agree to provide accurate information relevant to my appointment and to inform Baby Bear 3D4D Ultrasound LLC of any relevant circumstances that may affect the session. I understand that Baby Bear 3D4D Ultrasound LLC may refuse or discontinue a session when the requested service is outside the business's permitted scope, policies, equipment capabilities, or safety requirements.*

8. LIABILITY / RELEASE

To the extent permitted by applicable law, by checking this box, I agree that Baby Bear 3D4D Ultrasound LLC will not be liable for my decision to rely on an elective ultrasound in place of medical care, for medical conditions not detected because this is not a diagnostic examination, or for image-quality limitations inherent in

elective ultrasound. I understand that this paragraph does not waive rights that cannot legally be waived under California law.*

9. PRIVACY & IMAGE STORAGE

I understand that Baby Bear 3D4D Ultrasound LLC may create and temporarily store ultrasound images and appointment information as reasonably necessary to provide the service, deliver images, process payment, and maintain business records. I understand that Baby Bear 3D4D Ultrasound LLC will not use my photographs, ultrasound images, name, testimonial, or other identifying information for advertising or social media without a separate written marketing/photo release.*

10. ACKNOWLEDGMENT

By signing below, I confirm that I have read this document, understand the elective and keepsake nature of the service, have received the California Health & Safety Code §123620 disclosure above, and voluntarily consent to the requested elective ultrasound experience.