M3 Orthotic Consent & Payment Term M3 Podiatry Orthotics "*" indicates required fields Orthotics Dispatch Consent Form. Name* First Last Payment & ACC CoverACC Orthotics require us to apply for funding, please note this process can take up to 4-6+ weeks for Approval and a further 1-2 weeks to make and dispatch. There is no co-payment required for ACC funded orthotics. Our reception team will be in contact once your ACC Orthotic claim has been accepted and Orthotics are ready for order and dispatch. Please note we require a 15min appointment to for you new orthotics to your shoe. Private Orthotic orders require a deposit of %50 prior to order and take 1-2 weeks to Dispatch. I acknowledge if my ACC is declined or invalid/expired I am personally liable for the treatment costs* Yes I acknowledge that Orthotics are custom made and cannot be refunded or returned.* Yes Thank you from the team at M3 Clinic