Today's DatePackage Full Name Mom's Date of Birth Contact Phone Number Street Address City Zip Code State MarylandVirginiaWashington, D.C.Your Email I DO NOT want to receive email notifications for newsletters, events, special, classes etc.YesNoHow many weeks are you?Single or Twin Pregnancy?Expected Due DateAre you having a Boy or Girl?If unknown do you wish to know the gender of your baby?YesNoPhysician Name Physician Phone Number Physician Addess City Zip Code State MarylandVirginiaWashington, D.C.Any problem with your pregnancy? If yes, please explain:When was your last ultrasound?Were the results normal?YesNoIf no, please explain:How did you hear about us?NO PHOTOGRAPHY OR VIDEO RECORDING IS ALLOWED IN THE ULTRASOUND SCAN ROOM, BY YOU OR ANYONE IN YOUR PARTY. Thanks for respecting our policy!I verify the accuracy of the information above. I authorize PRECIOUS VIEWS to disclose medical information to my healthcare provider if necessary. I understand that I am financially responsible for charges related to this ultrasound.
