Practice Insurance Quote
Your Details
Full name: (incl Title)
*
Contact telephone number:
*
Email address:
*
Practice Details
Name of practice: (legal entity)
*
Practice address:
*
Postcode:
*
Practice type:
*
Please select
Dentist
Prosthetist
Dental Laboratory
Orthodontist
Dental Surgeon
Insurance Requirements
Property cover required
Yes
No
Business Interruption cover required
Yes
No
Public Liability cover required
Please select
$20 million
$10 million
$5 million
Glass cover Required
Yes
No
Money cover Required
Please select
$1,000
$2,000
$5,000
Cover for mobile phones or laptops (away from your practice)
Yes
No
Machinery or Electronic Breakdown cover required
Yes
No
Please use this box to provide any further information that may be relevant to your Practice Insurance policy :
Current Practice Insurance provider:
*
If none, please state
Current Practice Insurance premium:
*
If none, please state
Renewal date of existing insurance/date cover to start (as applicable):
*
NB: Cover is not in force until agreed upon by the company
Contacting You
Are you an existing Dental Essentials customer?
*
yes
no
Preferred contact method:
*
Please select
Telephone
Email
Letter
Preferred contact time:
Please select
No preference
08:00-10:00
10:00-12:00
12:00-14:00
14:00-16:00
16:00-18:00
How did you hear about us?
*
Please select
Referred by friend
Referred by another business
Referred by another website
Search engine
Advertising