Medical practices & clinics
Books and taxes for elective ultrasound studios.
Package tiers with keepsake add-ons, gift certificates sold months before they're redeemed, and reschedules when baby isn't in position. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
December came in at $13,700. Gift certificate sales ran heavy for the holidays, so I kept that revenue separate until it's actually redeemed for a session.
- HD 4D package sessionsSession package revenue
- Gift certificate salesGift certificate revenue
- Heartbeat bear and keepsake ordersKeepsake product sales
- Keepsake product supplierKeepsake product inventory
- Ultrasound equipment leaseImaging equipment
Why your books are different
An ultrasound studio's books go wrong around packages, gifts, and reschedules.
You're not billing insurance and you're not treating anyone, you're selling an experience in tiers, with gift certificates bought months ahead and reschedules built into how the business runs. A generalist has no framework for any of that.
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1
Gift certificates get spent before they're redeemed
A gift certificate bought for a baby shower or a holiday gift is often purchased months before the session actually happens, and booked as revenue the day it's sold, it overstates that month for a session that hasn't been delivered yet.
What we doKeeps gift certificate revenue separate until it's actually redeemed for a session, so income shows up when the visit really happens. -
2
Keepsake products blend into session package revenue
USB downloads, framed prints, and heartbeat recording bears sold alongside a session carry retail margin, not session margin, and blended together you cannot tell which one is actually padding the bottom line.
What we doKeeps keepsake product sales and their cost apart from session package revenue, so the real margin on each stays visible. -
3
Reschedules and refunds need their own tracking
A session rescheduled because the baby wasn't in a good position, sometimes with a partial credit or refund, can look like lost revenue if it's not distinguished from a true cancellation.
What we doKeeps reschedule credits and refunds in their own line, so a normal reschedule reads as exactly that, not as a canceled sale. -
4
Package tiers blend into one flat session number
A basic peek session and a full HD 4D package with keepsake add-ons bring in very different amounts, and if both land in one generic session category, you can't tell which tier patients are actually choosing.
What we doKeeps package tiers visible against each other, so you can see which one is actually filling the calendar.
Your categories
The categories Gus keeps for an ultrasound studio.
Set up once for how packages, gifts, and keepsakes all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Session package revenueBasic, gender reveal, and full HD 4D packages, tracked by tier.
- Gift certificate revenueCertificates sold ahead of time, tracked apart until redeemed.
- Keepsake product salesUSB downloads, framed prints, and heartbeat bears sold at the studio.
- Reschedule and add-on feesAny fees tied to extending or adding to a booked session.
Money out
- Keepsake product inventoryFrames, USB drives, and heartbeat recording bears purchased from suppliers.
- Imaging equipmentUltrasound machines, logged so they get written off right.
- Studio staff wagesSonographers and front desk staff, kept apart from each other.
- Rent and utilitiesThe studio space, including viewing rooms.
- Liability insuranceCoverage appropriate for an elective, non-diagnostic service.
- Marketing and social mediaAdvertising and content that drives bookings and gift certificate sales.
- Scheduling softwareBooking and payment tools for sessions and gift certificates.
What we watch for you
- Gift certificate balance
How much gift certificate revenue is still unredeemed and owed as a future session.
- Keepsake product margin
What keepsake products bring in against what they cost, kept apart from session revenue.
- Package tier mix
Which package tiers patients are actually choosing, tracked from session revenue.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things ultrasound studio owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
I keep it separate until the certificate is actually redeemed for a session, so the month it's sold doesn't get overstated for a visit that hasn't happened yet.
I keep package tiers visible against each other, so you can see which one is filling the calendar instead of guessing from one flat total.
No, I keep reschedule credits in their own line, so it reads as a normal part of the business, not as a lost sale.
The tax side
The tax side of an ultrasound studio.
Most of what matters here is timing gift certificate revenue correctly and tracking keepsake product inventory.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Gift certificate revenue timingMoney from an unredeemed gift certificate is generally not recognized as income until the session is delivered, which keeps the return matched to when the service actually happens.
- Keepsake product inventoryFrames, USB drives, and other keepsake products held for sale are generally tracked as inventory, with their cost recognized as items sell rather than when purchased.
- Imaging equipment purchasesUltrasound equipment can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- The pass-through deductionMost owners can take up to 20 percent of business profit off their taxable income. It comes out right when session, gift certificate, and keepsake revenue are all kept straight all year.
Deductions elective 3D and 4D ultrasound studios miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Keepsake product inventory
- Imaging equipment maintenance
- Liability insurance
- Marketing and social media costs
- Scheduling and booking software
- Studio furnishings and decor
- Sonographer training and certification
- Printing and framing supplies
- Gift packaging materials
- Business licenses
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
An ultrasound studio year, kept every month.
Gift certificates, holiday bookings, and package tiers each run on their own rhythm. Your taxes come on a fixed schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with gift certificates still being redeemed.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether package tier mix or keepsake sales changed the number.
- October
Before holiday gift season
Gus looks at what keepsake inventory to stock before December, when gift certificate sales usually pick up.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for elective 3D and 4D ultrasound studios. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions ultrasound studio owners ask first.
Do you handle insurance billing since we do ultrasounds?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Elective ultrasound sessions are cash-pay, and Gus works from what actually lands in your bank account.
How do you handle a gift certificate that never gets redeemed?
It stays tracked separately from earned revenue. What to do about an unredeemed certificate after a long period is a policy question for you and your accountant.
We sell keepsake products alongside sessions. Does that need separate bookkeeping?
Yes, and Gus already keeps keepsake sales and their cost apart from session revenue, so the real margin on each is visible.
Do reschedules for fetal positioning count as lost revenue?
No, Gus keeps reschedule credits in their own line, so they read as a normal part of running the business rather than a canceled sale.
Is it worth knowing which package tier is most popular?
Many owners find it useful for planning staffing and marketing. Gus keeps tiers visible against each other so that's a number you can actually look at.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever