Oasis of Hope P.P.S.C.

Pregnant Ultrasound Model Sign-Up

Here at Oasis of Hope Pregnancy & Parenting Support Center, we are always looking for ways to learn more! We will be offering Non-Diagnostic Obstetrical Ultrasounds free to the public to allow our Nurses the opportunity to conduct practice scans. We will be holding intensive training for our Nurses on October 9th, 23rd, & 25th. To request an appointment to be a pregnant ultrasound model, please fill out the form below. This training is open to anyone 6 through 22 weeks pregnant, and is done to better equip our Nurses to be able to show the precious miracle of life to those coming to our center in need of our services. These ultrasounds would consist of a transabdominal and optional transvaginal scan to get our Nurses confident with the ultrasound equipment and scanning of the female pelvis. Between 6-7 weeks, a transvaginal ultrasound would be best for scanning/learning about early pregnancy. A registered and experienced Obstetrical/Gynecological Ultrasonographer will be working right alongside our female Nurses in training. Appointments will last no longer than 1 hour. Feel free to bring any family and friends to join you. Due to limited availability & needed training, this form does not promise you an appointment. We will have a team member call to confirm your appointment.

WE HAVE FILLED OUR SPOTS FOR ANYONE ABOVE 22 WEEKS PREGNANT.

*Please note we will only allow you to make 1 appointment each week for both intensive training weeks. All Training days will be performed at our center- 710 N. Court St., Medina, OH 44256

First Name:

Last Name:

Birth Date (DOB):

Phone Number:

We will contact you with this phone number.

Email:

Last Menstrual Period (LMP):

Current Gestational Age:

Estimated Due Date:

Are you in prenatal care:

Yes

History of Tubal Ligation or Ectopic Pregnancy:

Yes

Allergic to latex:

Yes

Are you having active vaginal bleeding:

Yes

Do we have your approval to perform:

Transvaginal

Transabdominal

Both

Appointment Request(s):

Saturday, October 25th

8:00 AM

11:45 AM

I am not requesting this date.

Additional Questions or Comments:

As noted above, we will call to confirm your appointment date & time. Thank you for your willingness to help us learn more! We will be in touch with you shortly.