Text|Call @ 443.223.4141
Mom's Information & Consent Form
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Mom's Date of Birth
Last Menstrual Period Date (LMP)
City, County & State
At Which Location Is Your Appointment?
Which Ultrasound Session Did You Pick?
Baby in 2D - $75
Baby in 3D - $125
Baby in HDlive4D - $175
What Defines The Primary Purpose Of Your Visit?
Check Baby's Growth
Know Baby's Gender
See Baby's Face
What Made You Chose Motherhood Ultrasound?
Simple & Straightforward Pricing
Early Gender Ultrasound at 13 Weeks
Evening & Weekend Appointments
25+ Years of Prenatal Experience
Location's Proximity to Home or Work
How Did You First Hear About Us?
Friends & Family
Please read & accept Motherhood Ultrasound's Consent Form & Refund Policy:
I hereby authorize Motherhood Ultrasound, LLC and/or its personnel to perform an elective 2D, 3D/4D and/or HD LIVE ultrasound on me and my baby. I understand that this ultrasound session is not performed for any medical reason, or to diagnose any medical condition. It is performed for baby bonding and entertainment purposes. I agree that this ultrasound service is not covered by my insurance and will be paid by me at the time of service. I understand that during this service image quality may vary depending on baby's position, placenta placement, amount of amniotic fluid and my size and weight. I understand there are no refunds for services rendered and/or purchased ultrasound sessions. If Motherhood Ultrasound is unable to detect baby's gender and/or produce baby's pictures/videos during the first ultrasound session, they will reschedule me for a second session free of charge. I am currently under a care of a physician and have had routine clinical appointments with my doctor, and will address all medical questions with my physician. I hereby waive and hold harmless Motherhood Ultrasound, LLC and/or its personnel for any negligence in any form whatsoever.
Yes, I Accept Motherhood Ultrasound's Consent Form & Refund Policy.
128 Lubrano Drive, Suite L-100, Annapolis MD
Monday . Tuesday . Wednesday . Thursday . Friday . Saturday
Hours: 10am - 8pm
50 West Edmonston Drive, Suite 204, Rockville MD
Tuesday . Thursday . Saturday
Hours: 11am - 8pm
22 W Pennsylvania Ave, Suite 206, Towson MD 21204
Hours: 11am - 8pm
Text or Call @ 443.223.4141
© 2017 Motherhood Ultrasound.