Medical Malpractice Form

MEDICAL MALPRACTICE - DENTIST AND ORTHODONTIST

PROPOSAL FORM

* Indicates required field

Full name of priviate doctor or entity to be insured *

The Insured's Business *

Contact Person *

First

Last

The amount of gross income/fees *

Email *

Comment *

If the Insured is a entity, provide total numbers of employees in each of the following classifications:

(a) Surgeons *

(f) Pharmacists *

(b) Doctors *

(g) Registered nurses *

(h) Enrolled nurses *

(d) X-ray technicians *

(i) Laboratory technicians *

(e) Other medical or allied health employees *

(j) Undergraduate of student staff *

Submit

We also offer bespoke and custom made policies to reflect the exposures of particular professions at the limit of indemnity and coverage to suit specific needs, whilst maintaining competitiveness and giving you the peace of mind that you are adequately covered. Please download Application Form and return in order for us to design a suitable quotation at [email protected].

Application Form

﻿﻿﻿MEDICAL MALPRACTICE - DENTIST AND ORTHODONTIST ﻿﻿﻿

﻿﻿PROPOSAL FORM﻿﻿

If the Insured is a entity, provide total numbers of employees in each of the following classifications:

MEDICAL MALPRACTICE - DENTIST AND ORTHODONTIST

PROPOSAL FORM