Dental Indemnity DigiMax

All Med Pro

Quotes for Dental & Medical Insurance

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Insurance type
About AMP
- Why AMP
- Our Story
- Our Team
- Careers
- Events
- Partners
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Client area
News
Contact

Step 1 of 5

20%

General Information
What month is your indemnity due?
Full Name*
Title First Last
Profession*
Phone*
Email*
Address*
First Line of Address Town Postcode
Hidden
Is your correspondance address any different to the above?
Hidden
Address*
First Line of Address Town Postcode

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Claims and Conduct
Please read the following questions carefully and answer all of them fully and truthfully.
1 - Have any complaints or claims been made, brought or threatened against you?*
Please provide further details on the above including circumstances, dates and costs
2 - Are you aware of any acts, errors, omissions, incidents, events, circumstances or requests for notes which may give rise to a complaint or claim against you?*
Please provide further details on the above including circumstances, dates and costs*
3 - Are you aware of any complaints, claims, acts, errors, omissions, incidents events or circumstances which may lead to an investigation, suspension, the imposition of conditions or restrictions on your registration or license to practice or your removal from a professional register or the removal of your license by a relevant registration body?*
Please provide further details on the above including circumstances, dates and costs*
4 - Are you aware of any complaints, claims, acts, errors, omissions, incidents, events or circumstances which may lead to disciplinary actions or suspension of practice?*
Please provide further details on the above*
5 - Have you ever been subject to any form of disciplinary action?*
Please provide further details on the above including circumstances and dates*
6 - Have you ever had conditions to practice, been suspended or restricted from practice or dismissed from practice?*
Please provide further details on the above including circumstances and dates*
7 - Have you ever been subject to any form of investigation or adverse finding by a registration body or equivalent in any country?*
Please provide further details on the above including circumstances and dates*
8 - Have you ever been admitted to or sought treatment from any mental health or chemical / substance abuse programme?*
Please provide further details on the above including circumstances and dates*
9 - Have you ever been refused registration or license to practice or been erased from registration or had your license to practice suspended or removed by a registration body?*
Please provide further details on the above including circumstances and dates*
10 - Have you ever had any restrictions or conditions imposed on your registration or license to practice by a registration body?*
Please provide further details on the above including circumstances and dates*
11 - Have you ever been the subject of a Medical Defence Organisation’s adverse member procedure?*
Please provide further details on the above including circumstances and dates*
12 - Has any Medical Defence Organisation ever declined to offer you membership, terminated or restricted your membership or refused to renew your membership?*
Please provide further details on the above including circumstances and dates*
13 - Has any insurance indemnity provider ever declined to insure you, imposed special terms, cancelled or refused to renew your insurance?*
Please provide further details on the above including circumstances and dates*
14 - Are you being investigated, or have you ever been convicted of a criminal offence or received a formal police caution (not spent under the Rehabilitation of Offenders Act 1974) in any country?*
Please provide further details on the above including circumstances and dates*
15 - Have you ever suffered a loss of personal information as a result of a privacy breach?*
Please provide further details on the above including circumstances and dates*
16 -Have you ever suffered a loss through the fraud or dishonesty of any other person(s) or are you aware of any matter which may lead to a claim against your employees such as staff, associates, dental nurses etc.*
Please provide further details on the above including circumstances and dates*

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You and Your Practice
Date of birth*
DD slash MM slash YYYY
How many sessions per week do you work?*
Please enter a number less than or equal to 14.
What is the total annual fee income derived from your dental activities?*
In which country did you qualify?*
What is your GDC registration number?*
Are you a practice owner?*
Will you be retiring in the next 5 years?*
What date are you looking to retire?
DD slash MM slash YYYY
Are there or have there been any conditions or interruption attached to your GDC registration?*
Please provide additional information in respect to your GDC registration*
Please select your previous indemnity providers
- Dental Protection
- DDU
- MDDUS
- Hiscox
- InSync
- MIAB
- Towergate
- MMI4U
- DIA
- Other Provider
- No Previous Insurance
Dental Protection*
Please provide the dates that you were covered with Dental Protetcion
DDU*
Please provide the dates that you were covered with DDU
MDDUS*
Please provide the dates that you were covered with MDDUS
Hiscox*
Please provide the dates that you were covered with Hiscox
InSync*
Please provide the dates that you were covered with InSync
MIAB*
Please provide the dates that you were covered with MIAB
Towergate*
Please provide the dates that you were covered with Towergate
MMI4U*
Please provide the dates that you were covered with MMI4U
DIA*
Please provide the dates that you were covered with DIA
Other Indemnity Provider*
Please provide the dates that you were covered with other indemnity providers including the providers name
What date do you require the policy to incept/start?
DD slash MM slash YYYY
Has prior cover been on a “Claims Made Basis”?
If you know your retroactive date please provide
DD dot MM dot YYYY
Has there ever been any gaps in your indemnity coverage?*
Please provide full details of any gaps in coverage including dates*
Do you have an updated claims history or letter of good standing from your previous indemnity provider(s)?*
Letter of Good Standing
Please upload your letter of good standing if you have it to hand
Drop files here or

Max. file size: 64 MB.
Clinical Activities
Please select your clinical activities*
- General Dentistry
- Orthodontics
- Implantology
- Oral or Maxillofacial Surgery
- Facial Aesthetics (Botox and fillers)
- Cosmetic Dentistry
- Surgical Periodontal Procedures
What % of your time is spent on General Dentistry?*
Please enter a number less than or equal to 100.
What % of your time is spent on Orthodontics?*
Please enter a number from 1 to 100.
What % of your time is spent on Implantology?*
Please enter a number from 1 to 100.
What % of implants involve sinus lifts?
Please enter a number from 0 to 100.
What % of your time is spent on Facial Aesthetics?*
Please enter a number from 1 to 100.
What % of your time is spent on Oral or Maxillofacial Surgery?*
Please enter a number from 1 to 100.
What % of your time is spent on Cosmetic Dentistry?*
Please enter a number from 1 to 100.
What % of your time is spent on Surgical Periodontal Procedures?*
Please enter a number from 1 to 100.
Total Clincial Split Percentage %*
Must equal 100%
Are general anaesthetics ever administered?
- Yes
- No
Facial Aesthetics
Please provide the annual number of botox procedures
Please provide the annual number of collogen fillers
Please provide the annual number of facial peels
Please provide the annual number of other
Your Cover
What level of indemnity cover do you require?*
- £2,000,000
- £5,000,000
- £10,000,000

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Addendum
Please select any oral or maxillofacial surgery that you undertake.
Dento-alveolar procedures - Surgical treatment of disorders of the teeth and their supporting hard and soft tissues.
- Select All
- Apicectomies
- Exodontia (eg, wisdom teeth removal)
- Benign cyst removal
- Minor pre-prosthetic surgery
- Tooth transplantation
- Surgical removal of teeth
- Removal of impacted or ectopic teeth, including wisdom teeth
- Removal of developmental abnormalities of the teeth and jaws
- Benign jaw growth removal
- Dental implants (excluding sinus lifts or bone augmentation which involves the floor of the sinus, or extra-oral bone harvesting, all of which are regarded as maxillofacial procedures).
- Dental implants (including sinus lifts or bone augmentation which involves the floor of the sinus, or extra-oral bone harvesting, all of which are regarded as maxillofacial procedures).
- Trauma - Rhinoplasty, pinnaplasty, genioplasty
- Facial aesthetics - Rhinoplasty, pinnaplasty, genioplasty
- Cleft lip and palate
- Head and neck cancer
- Craniofacial surgery - Craniosynostoses, Craniofacial dysostoses, Orbital
- Skull base surgery
- Orthognathic surgery
Are you a member of the British Association of Oral and Maxillofacial surgeons?*
Are you a member of any other professional organisation?*
Do you personally administer general anaesthetics?*
Do you have the relevant post-graduate training and experience to administer general anaesthetics?*
Is the general anaesthetic administered by a dentist or medical practitioner with the appropriate post-graduate training and experience?*
Does the person administering the general anaesthetics (the Anaesthetist) always remain with the patient throughout the procedure and until the patient's protective reflexes have returned and the patient has gained control of their own airway?*
Does the Anaesthetist always have an assistant in support throughout the procedure and recovery?*
Is sedation ever administered?*
Is the IV sediation administered by you?*
What type of practitioner is the IV sedation administered by?*
General Anaesthetics
What type of sedation is administered?*
- Intravenous
- Inhalation / RA
Is the operating room equipped with continuously-acting monitoring devices and a defibrillator?*
Is there basic life support equipment set up in the operating room?*
Is the patient's full medical history always taken prior to administration of general anaesthetics/sedation?*

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Declaration*
You declare and warrant that after enquiry all statements and particulars contained in this Proposal and addendum are true and that no information whatever has been withheld which might increase the risk of The Company or influence the acceptance of this Proposal and should the above particulars alter in any way you will advise The Company as soon as practicable.

You understand that failure to disclose any material facts which would be likely to influence the acceptance and assessment of this Proposal may result in The Company refusing to provide indemnity or voiding the Policy in every respect. You hereby agree and accept that this Declaration shall be the basis of the contract between both parties if entered into.

You confirm that as of the date hereof you have appointed All Med Pro as your exclusive Insurance Broker with respect to the above coverage. The appointment of All Med Pro rescinds all previous appointments and the authority contained herein shall remain in full force until cancelled in writing.

I agree to the above declaration
What is your current renewal premium?*
If you wish to supply additional information please provide below
Supporting Information
You may wish to supply supporting information such as your CPD log
Drop files here or

Max. file size: 64 MB.
Phone
This field is for validation purposes and should be left unchanged.

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CONTACT US

Email:
info@allmed.co.uk
Enquiries:
0203 7576950
Address:
All Med Pro, Units 15-17 Lotmead Business Village, Wanborough, Swindon, Wiltshire, SN4 0UY

Find us on:

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Cookie & Privacy policy
Cookie settings
Terms of Business
COVID-19 Statement

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All Med Pro is a trading style of All Medical Professionals Limited who are authorised and regulated by the Financial Conduct Authority Number: 309653.
All Medical Professionals Limited registered in England number 4468555. Registered office: Unit 15-17, Lotmead Business Village, Wanborough, Swindon SN4 0UY
© All Medical Professionals Limited 2017.

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Step 1 of 5

General Information

Claims and Conduct

You and Your Practice

Clinical Activities

Facial Aesthetics

Your Cover

Addendum

General Anaesthetics