No or Low Cost Ultrasound – Provider Information Form

Introduction
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The Code of Virginia Section 18.2-76 requires the Virginia Department of Health to maintain "a statewide list of public and private agencies and services that provide ultrasound imaging and auscultation of fetal heart tone services free of charge."

This survey was designed to identify facilities providing free or "low-cost" ultrasound and or auscultation services for pregnant women. Auscultation services refer to the procedure which detects audible fetal heart beats. This information will be used to meet the Code mandate in an effort to update the Virginia Providers of Ultrasound Services as well as provide other useful information to women seeking ultrasound services in the Commonwealth.  The results will be available on the following VDH web addresses:

 This survey should take 5 -10 minutes to complete.

1. What is the facility name, address, and phone number? *This question is required.
2. What is your name and position title?
Your email address is needed so that we can send you a screenshot of your information. Once you verify the information submitted, it will be uploaded to VDH's Web site.
3. Does your facility want to be listed on the Web sites below as a provider of free or lost cost ultrasounds? *This question is required.