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Get Baby Pictures Prenatal Care Verification Report/ Patient Consent

N REPORT/PATIENT CONSENT FORM To: Baby Pictures Ultrasound RE: 4D Ultrasound _________________________________________ is currently a patient under my care for her pregnancy and is approved to receive either a 2D or 3D/4D ultrasound at Baby Pictures Ultrasound. ______________________________________________________ Provider (Print) Date ______________________________________________________ Signature Date ______________________________________________________ Phone PATIENT CONSENT TO RELEASE F.

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