Get Admiral Insurance Group Dentists Professional Liability Application 2020-2025

Filling out the Admiral Insurance Group Dentists Professional Liability Application online is a crucial step for dental professionals seeking liability coverage. This guide provides clear, step-by-step instructions to help you complete the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application and open it in your preferred editor.
2. Begin by filling in your full name as the applicant in the designated field.
3. Provide your degree and principal practice address, ensuring accuracy for future correspondence.
4. List any additional practice locations if applicable, and include your home address for identification purposes.
5. Enter your website URL, Social Security Number, DEA Number, date of birth, and place of birth in the respective fields.
6. Indicate your U.S. citizenship status and provide any relevant information if you are not a citizen.
7. Document the dental school from which you graduated, including the city, state, country, degree, and year of graduation.
8. Summarize your practice history since completing training with addresses and dates.
9. List memberships in any professional societies, license states, and numbers relevant to your practice.
10. Specify the type of practice you maintain and whether you seek coverage for this entity.
11. Detail the names of dentists or oral surgeons practicing under your named entity if applicable.
12. Provide information on any additional dentists you practice with and your relationship to them.
13. Outline facilities where you practice and your interest level in each.
14. Indicate if you require coverage for all listed facilities and clarify any exclusions.
15. Report the number of professionals you employ or contract, noting who carries their own malpractice coverage.
16. Confirm the licensing status of all individuals listed previously.
17. Detail your specific dental specialty and indicate if you limit your practice to that field.
18. Specify annual revenue, average patient load, and weekly hours of practice.
19. Provide the approximate percentage breakdown of your practice across various procedures.
20. Confirm whether you use written informed consent for procedures and attach relevant forms if applicable.
21. Answer questions regarding any sedation or anesthesia you administer to patients.
22. Address any past investigations, disciplinary proceedings, or claims against you.
23. List prior medical malpractice insurance coverage for the previous five years.
24. Indicate any other facilities where you provide services and describe them.
25. Detail any anticipated changes in your practice.
26. Finally, review your completed application, save changes, and choose to download, print, or share the form as needed.

Complete your application online today to ensure you are adequately protected!