I certify that I am currently under the ongoing care of a licensed obstetrician or qualified prenatal healthcare provider for this pregnancy.

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I confirm that I have undergone, or will undergo, a diagnostic ultrasound as recommended by my OB or healthcare provider to evaluate fetal health, confirm gestational age, and screen for any complications.

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I understand that Bloom Ultrasound and Pregnancy Spa is a non-medical facility and does not provide diagnostic, therapeutic, or medical evaluations. All medical concerns should be addressed by my licensed healthcare provider.

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I acknowledge that:

• The ultrasound provided by Bloom is a limited, elective, non-diagnostic session focused on capturing keepsake images and videos of my baby.

• The session will typically last no more than 25 minutes and will focus on the pelvic region.

• This ultrasound is not a replacement for any diagnostic imaging ordered by my provider.

• There is a possibility that fetal gender determination may be inaccurate.

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I understand that the technician performing this service is trained in sonography for non-diagnostic purposes only and is not a physician, nurse, or licensed healthcare provider. They will not interpret or diagnose any condition, nor provide medical advice related to the images captured.

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I affirm that:

1. I am voluntarily requesting this ultrasound for personal and keepsake purposes only.

2. I have informed, or will inform, my healthcare provider that I am receiving a non-diagnostic ultrasound at Bloom.

3. I take full responsibility for notifying my provider about the session and any images obtained.

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I further understand:

• This session is elective and may not be covered by health insurance. Pre-payment is required.

• Image and video quality may vary based on factors such as fetal position, gestational age, and maternal anatomy.

• Bloom cannot guarantee specific image clarity, fetal visibility, or the outcome of any media provided.

• Recording or distributing video content from the session that is not produced or authorized by Bloom is prohibited.

• All images and video clips taken during the session may be used by Bloom for marketing or promotional purposes, unless I request otherwise in writing.

• I agree to receive emails, text messages, and promotional content from Bloom and accept delivery of my session materials via email and/or smartphone.

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I also understand:

• Bloom makes no guarantees regarding the accuracy of gender identification or any other fetal traits.

• While current research suggests that ultrasound is safe for mother and baby, I accept that future findings may present unknown risks.

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In consideration of receiving services from Bloom Ultrasound and Pregnancy Spa, I release and hold harmless Bloom, its owners, employees, affiliates, and representatives from any and all claims or liability, including but not limited to:

• Misidentification of fetal gender or characteristics,

• Misinterpretation of ultrasound images,

• Any unforeseen risks or outcomes related to the elective ultrasound session.

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By proceeding with booking, I confirm that I have read, understood, and voluntarily agree to all terms outlined above.