Quick Quote for Physicians

Please use this Quick Quote form to submit your current info to PRI, so that we may give you a fast estimate on coverage costs. Or, contact Marketing Department, at 800-632-6040, email: CONTACT-US@PRI.com

Fields with a * are required.

CONTACT INFORMATION

*
*
*
*
*
*
*
*

PROFESSIONAL LIABILITY INSURANCE HISTORY

*
* Surgery
No Surgery
Minor Surgery
2. Choose the number of consecutive years with full malpractice insurance coverage without a claim paid in excess of $25,000 - $50,000
*
*
* Years of continuous coverage immediately preceeding this year.
* Full Time
Part Time
Chiropractor
Nurse Anesthetist
Nurse Midwife
Nurse Practitioner
Physician's Assistant
Optometrist
Podiatrist
5. Expiration and Retroactive dates found on the cover page of your present policy
*
*
* $500,000 / $1,500,000
$1,000,000 / $3,000,000
Risk Management Program
No Consent Option
MagnaCare Member
Part-time
 
ALL QUOTES ARE ONLY AN ESTIMATE.
A PRI application will have to be filled out for an actual quote.