Volunteer form

Thank you for helping us grow to better serve you and the community!

Volunteer Scan

First & Last Name

Birthday

Month

Day

Year

Phone

This scan is performed at Peek Ultrasounds home-based office.

By providing the DATE of your AGREED APPOINTMENT, you agree to our booking terms.

Month

Day

Year

Please provide the DATE of your agreed appointment.

By providing the TIME of your AGREED APPOINTMENT, you agree to our booking terms.

Time

HoursMinutes

Please provide the TIME of your agreed appointment.

How many weeks are you?

Do you know gender?

Have you had your anatomy scan?

Is there any additional information you would like us to know?

Are you under the care of a medical provider?

Yes

I understand that this scan is for training purposes and is not intended to diagnose or replace my Dr's care. I agree to allow Peek Ultrasounds staff to perform an anatomy scan of my baby. (30mins or less).

I understand

I understand that this scan is for training purposes and is not intended to diagnose or replace my Dr's care. I understand that I will NOT receive any diagnosis or diagnostic information such as: measurements or abnormalities.

I understand

Would you like to join our monthly email list. Filled with fun facts, promotions and exclusive deals?

Yes