I understand that a representative of Sam Audio will take an impression of my ear for the purpose of creating custom fit in-ear monitors. I understand that prior to making the impression the Representative shall visually inspect my inner and outer ear to make sure there are no blockages or abnormalities that would prevent from making a proper impression and/or injure me.

I understand that the Sam Audio Representative is fully trained and capable of taking ear impressions. Sam Audios Representative reserves the right to refuse to make ear impressions for any reason and to refer me to an ENT doctor.

I understand that in very rare circumstances, ear impressions may cause damage in the ear canal that may require medical intervention and/or that can damage my ear.

In the light of the foregoing, I agree to indemnify, release, and forever hold harmless Sam Audio Representatives and Sam Audio US from any and all claims, damages and/or legal actions arising from or connected in any way with the ear impressions administered by Representative.

I HAVE READ AND UNDERSTAND THE FOREGOING AND BY FILLING OUT THE INFORMATION I AGREE TO THE ABOVE STATED.