Clear Image Ultrasound

Confirmation Letter

Attention Doctor ………………………………………………………………………………………………………………………………………………………

This letter is to inform you that Patient:

…………………………………………………………………………………………………………………………………………………………………………………………

Intends to have an Ultrasound session in Clear Image Ultrasound Medical Center.

Your Patient will have 2D/3D/4D Ultrasound Session which includes
Basic Fetal Wellbeing Assessment:

-heart rate
-fetal presentation
-fetal movements
-fetal breathing
-placental location
-amniotic fluid

along with 3D/4D Ultrasound real live imaging of the baby recorded on DVD (VHS) and CD.
Limited report will be sent to you. CD with digital images is available upon your request.

Please, confirm that the Patient is currently under your medical care and have had diagnostic medical ultrasound exam (Level 1 or Level 2) performed and is aware of the results.

Doctor's Signature

Date

Patient's Signature

Date

Is Ultrasound Safe? Yes.

There are no known harmful effects associated with the medical use of Sonography. Widespread clinical use of diagnostic ultrasound for many years has not revealed any harmful effects. Studies in humans have revealed no direct link between the use of diagnostic ultrasound and any adverse outcome. Although the possibility exists that biological effects may be identified in the future, current information indicates that the benefits to patients far outweigh the risks ( American Institute of Ultrasound in Medicine statement ).

We are operating our facility in accordance to the rules and regulations for Ultrasound Safety. All exams are performed by RDMS Sonographers.

Please, contact us to receive additional information and brochures.

Clear Image Ultrasound Corp.

1829 East 13 th Street Suite 1
Brooklyn, NY 11229
Phone 718-339-9400
Fax 718-339-9410
E-mail contact@ciu4d.com
Web-site www.ciu4d.com