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Practice Owner
Quote Request

Tell us about your practice — we’ll build a coverage strategy that protects everything you’ve worked to create.

Coverage Selection

Select all that apply *

Please select at least one coverage type.

Practice Information

Please enter a requested effective date (MM/DD/YYYY).
Please enter the date your business was established (MM/YYYY).
First name is required.
Last name is required.
A valid email address is required.
Phone number is required.

Preferred Method of Contact *

Please select at least one contact method.

Company legal name is required.
Please select your specialty.

Practice Location

Physical address is required.
City is required.
State required.
Zip code is required.

Business Owner’s Policy Details

Includes property, liability, and other important coverage for a business owner.

Square footage is required.
Please enter a coverage amount.

In a worst case scenario: what would it cost to replace all contents, equipment, finish out, furniture, etc.

Do you own the building? (optional)

Is this a condo unit? (optional)

Standard Business Owner’s Policies Exclude Coverage for Losses Due to Floods & Earthquakes:

Would you like a quote for flood insurance? (optional)

Would you like a quote for earthquake insurance? (optional)

Workers’ Compensation

Payroll Frequency (optional)

How often do you pay your employees?

Other Coverage

Do you pay for, or reimburse, associates for their malpractice? (optional)

Do you provide health insurance for your employees? (optional)

Does your business have a 401K or pension plan? (optional)

Do you own any vehicles in the name of the practice? (optional)

If you are too sick or hurt to work, do you have enough disability insurance to:

Keep your practice doors open? (optional)

Continue to make your loan payment(s)? (optional)

Additional Information

I’m also interested in: (optional)

Please note: the information upon which quotes are based is on the information you have provided. As this information could be subject to error, Insurance by Dentists cannot guarantee the correctness of the rates quoted.

This form is for proposal use only. An application is required for coverage, subject to underwriting review and approval.

* Required fields Please fill in all required fields above.

Quote Request Submitted

Thank you — one of our Insurance by Dentists specialists will review your information and be in touch with you shortly.