300 Spindrift Drive
Amherst, NY 14221
(800) 728-6362
(716) 633-3400









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Request Chiropractor Professional Liability Insurance Quote

We are pleased to offer you a quotation on your insurance. Please fill out the form below & click on the submit button. We will process your application and contact you with a detailed presentation.
Fields marked with a red * are Required. Please provide us with a working email address and phone number, so that we can contact you.

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Fax:

Coverage Start Date*:


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Current Insurance Coverage
Current Annual Premium:

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If Claims-Made give Retroactive Date:


Coverage Desired on Quote

Type of Business:

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Each Person Coverage Limit:

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Date your Practice began:


What are the total number
of practice hours per week
for both direct patient care
and related administrative
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By filling out this form, it in no way represents binding insurance coverage.
This application is used to quote your insurance only.
We may not provide insurance in your state and we will advise you in an e-mail if you do not qualify.
Any information that you provide to Scott Danahy Naylon is private and kept confidential.
Please refer to the Legal page for full details.


 
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