Instructions: Please complete the below information accurately.

Full Name

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Your Phone Number

Shoe Size (Required)

Insole Type (Required)

I, the undersigned, hereby acknowledge and understand that Innovative Technology Products and its trademarks and brands, including Instant Insoles, are not medical personnel and are not providing medical advice. The analysis performed by their AI machine is solely an electronic analysis of my feet for the purpose of producing custom-made insoles.
I understand that this analysis is not a substitute for professional medical advice, diagnosis, or treatment. I am responsible for seeking the advice of a qualified healthcare professional regarding any medical conditions or concerns I may have.
I hereby release and hold harmless Innovative Technology Products, Instant Insoles, its trademarks and brands, and their respective officers, directors, employees, and agents from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or relating to any information or recommendations provided to me during this analysis.

[Signature] I have read and understood the above release statement and agree to its terms.

Please Put Full Name as Signature (Required)

Date (Required)