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Dentists Professional Liability Insurance Quote

Dentist Professional Liability Insurance

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly. Free Premium Estimate Questionnaire (Non-Binding) Indication of Coverage Please answer all questions for a non-binding Premium Estimate.

Your Information

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Practice ZIP / Postal Code(Required)

Dental License #(s)(Required)

Practice Information (Please respond as completely as possible.) All sections, except section (D), are required for submission.

Date I started practicing dentistry

Average Hours per Week

Have you had any professional liability claims within the past 8 years?

Yes

If Yes, please provide details, status and amounts paid

Please check Per Claim / Aggregate limits in which you are interested

$1,000,000 / $3,000,000

$2,000,000 / $4,000,000

$2,000,000 / $6,000,000

$3,000,000 / $5,000,000

$4,000,000 / $6,000,000

$5,000,000 / $7,000,000

My current Professional Liability Insurer is

Expiration Date (Month / Day / Year)

Quotations and coverage may be issued only upon acceptance of a fully completed Medical Protective Company application

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