Dentists Professional Liability Insurance - Dentist's Advantage - Quote Form

For nearly half a century, Zutz has addressed the special needs of Dentists and Oral Surgeons and the insurance coverages their practices demand. Our expertise in this area has earned us the endorsement of the Delaware State Dental Society as well as The Philadelphia County Dental Society.

As the administrator for the "Dentist's Advantage" Program, Zutz can provide a comprehensive program of insurance designed specifically for your practice. We can provide a stand-alone professional liability policy or a complete package of insurance including property, general liability, workers' compensation, business auto and commercial umbrella coverage.

The "Dentist's Advantage" Program
is the only professional liability program
endorsed nationally by the
Academy of General Dentistry.

If you are a Dentist or Oral Surgeon practicing in Delaware, Pennsylvania, New Jersey, Maryland or the District of Columbia and would like an obligation-free quote for coverage through the "Dentist's Advantage" Program, please use the form below.

Zutz's Dental Underwriting Specialists:

Name	E-mail	Extension (302-658-8000)
Angel Reed		156
Marisol Alvarez		161
Bob Opperman		151
Sharon Ruth, Underwriting Mgr.		173
Kathy Maxey, Support Services		162

Dentists
Professional Liability Insurance
Quote Form

Contact Information
Practice Name:
Contact Name:
Address:
City:
State:	Zip:
Business Phone:
Fax:
E-mail Address:
Dental Specialty:

Professional Liability
1.	Do you use Conscious Sedation? Yes No
2.	Do you use General Anesthesia? Yes No
3.	Are you a Partnership or Corporation? Yes No
4.	Current Limits of Liability:
5.	Type of Coverage:
	If you have Claims Made, what is your Retroactive Date?
	If Yes, how many claims have you had?
6.	Current Insurance Carrier:
7.	Policy Effective Date:
8.	Are you a "New" practitioner within the last 3 years? Yes No
9.	Have you had any professional liability claims in the last 5 years? Yes No
10.	Have you attended a Risk Management Seminar in the last 3 years? Yes No
11.	Are you a member of the Academy of General Dentistry? Yes No If Yes, Membership Number:
12.	Are you a fellow or a master? Fellow Master
13.	Are you a member of the American Dental Association? Yes No
14.	What other dental association are you a member?

Property Package