Podiatry PLUS

Premier Professional Liability Insurance for Podiatrists

Obtain a Quote



Please complete this quote form with your current information and your local agent will be happy to provide you with a no obligation professional liability premium indication. Your local agent will contact you with your premium indication upon completion of this quote request.

Click here for the fillable PDF application which your agent will request prior to binding.

Podiatric Practice Name:  
Doctor's Name:  
Contact Name (if different):  
Address:  
City:  
County:  
State:  
Zip:  
Phone:  
Fax:  
Email:  
Current Policy Information
Carrier:  
Expiration Date:  
Retroactive "Prior Acts" Date:  
Type:    Claims Made    Occurrence
Limits:    $100,000/$300,000    $250,000/$750,000
 $1 Million/$3 Million  Other
Annual Premium:  

Practice Profile
Date Practice Started:  
Practing as a:    Owner    Employee    Ind. Contractor  
# of Podiatrists in Practice:    Employees    Ind. Contractors  
Type of Practice:    Solo    Partnership    Corporation  
# of hours worked/week:    hours
Are you Board Certified:    Yes  No
Prof. Organizations you belong to:
(ACFAOM, APMA, ACFS, AAFS and others)   

Risk Management Practices
Risk Management course completed within the past 2 years?:  
 Yes  No
Use of written informed consent for surgical procedures?:  
 Yes  No

Patient Profile
Percentage of your practice that involves the treament of
these patient types?:  
Athletes % Children %
Diabetics %    Other Higher Risk Patients %

Procedure Mix
Indicate the percentage of time spent annually in the following area (total must equal 100%):  
Non-Surgical Care* %
Soft Tissue Surgery %
Osseous Surgery %
*The following are considered "non-surgical": diagnostic and therapeutic injections; all nail related procedures; abscess incision and drainage; excision of molluscum contagiosum cysts and other benign legions (including warts and calluses); and treatment of ulcers.

Surgical Procedures Per Year
TOTAL # OF SURGICAL PROCEDURES PERFORMED PER YEAR: 
Estimated number of the following surgeries performed per year:  
Joint or Other Implants or Prosthesis 
Ankle Joint / Lower Leg Surgery 
Tendon Transfer Surgery 
Achilles Tendon Surgery 
Laser Surgery 
Minimal Incision Foot Surgery 
Bunion Surgery   
Non-Osteotomy 
Osteotomy 

Any Losses or Disciplinary Actions?  
If "yes" claims history will need to be provided.
 Yes  No




Please contact your Podiatry PLUS agent if you have any questions
or require assistance.

*Premium indications provided are not firm quotations and are not bindable. Terms, limits, deductibles, conditions and price may change upon receipt, review and acceptance of a completed application and supporting documentation by the company. A binding quotation will not be issued without the company's full underwriting due dilligence.

.