Medical Professionals

Healthcare Professional Insurance Quote

Comprehensive professional liability and practice protection for physicians, dentists, nurses, therapists, and allied health professionals. We work with specialized medical malpractice carriers to provide tailored coverage for your practice.

1 Contact Information

Contact Name *

Title / Role *

Email Address *

Phone Number *

Practice / Facility Name *

Search Google to find your practice and auto-fill your address

Practice Address *

City *

State *

Zip Code *

Website

Federal Tax ID (EIN)

2 Practice Information

Practice Type *

If Other, please specify:

Primary Medical Specialty *

Secondary Specialty (if any)

Years in Practice *

Business Entity Type

Annual Gross Revenue

Number of Practice Locations

3 Professional Credentials

State License Number *

License Expiration Date

NPI Number

DEA Number (if applicable)

Board Certified?

Board Certification(s)

Hospital Privileges?

Hospital Name(s)

4 Practice Operations

Annual Patient Visits *

Primary Practice Setting

Services Provided (check all that apply)

Office Visits / Exams Telehealth / Virtual Visits Minor / Office-Based Surgery Major Surgery (hospital/ASC) Injections / Infusions Cosmetic / Aesthetic Procedures Laser Treatments Sedation / Anesthesia Diagnostics / Imaging Laboratory Services Obstetrics / Deliveries Dispensing Medications Clinical Trials / Research Weight Loss Programs

Do you perform surgeries?

Annual surgical procedures (if any)

# of Physicians / Dentists

# of NPs / PAs / Midlevels

# of Nurses (RN, LPN, MA)

# of Admin / Support Staff

Total Employees

Annual Payroll

What coverages do you need? (check all that apply) *

Professional Liability / Malpractice General Liability Property / Building Business Personal Property / Equipment Workers' Compensation Cyber Liability / Data Breach Employment Practices Liability Directors & Officers Commercial Auto Umbrella / Excess Liability Business Interruption Crime / Employee Dishonesty

Malpractice Policy Type Preference

Desired Liability Limit

Desired Effective Date

Current Policy Expiration

7 Claims & Disciplinary History

Malpractice claims in past 10 years? *

Any open/pending claims?

License ever restricted/suspended?

Hospital privileges ever restricted?

If claims or actions, please describe:

Current Malpractice Carrier

Current Annual Premium

8 Additional Information

Preferred Contact Method

Best Time to Reach You

How did you hear about us?

Additional Comments or Questions

By submitting this form, you agree to be contacted by First Underwriters Insurance Brokers regarding your healthcare professional insurance quote request. Your information will be kept strictly confidential and used only for the purpose of providing you with quotes. Carriers may require additional applications, CV, or loss runs.

Have questions or prefer to speak with a healthcare insurance specialist? Call us directly.

(425) 242-5357

First Underwriters Insurance Brokers • Kirkland, WA • Since 1992