Quote Request TAKES LESS THAN 2 MINUTES TO COMPLETE Request Your FREE Quote! Step 1 of 2 - Business & Contact Information 0% Contact Name:(Required) First Last Business Name:(Required)Phone:(Required)Email Address:(Required) I Need A Quote For:(Required) Full-Time Medical Spa / Anti-Aging Practice With A Physical Location Mobile Practice Provider (I Have No Physical Location) Solo Physician Looking To Add Medspa / Anti-Aging Services To My Existing Medical Practice Functional Medicine Clinic Offering Primary Care / Urgent Care Services Liability Coverage For My Business Premises Only - I Already Have Professional Liability Coverage Other How Soon Do You Need The Right Insurance Policy Coverage?(Required) Less Than 30 Days In 30 to 60 Days In 60 to 90 Days More Than 90 Days I'm Not Sure If I'm Going To Offer Services Yet, I'm Exploring If Other, Please Describe What Coverage(s) You Looking For:(Required) Select All Practicing Personnel That Will Need Coverage On This Policy:(Required) Physician Nurse Practitioner Physician Assistant CRNA Nurses (RN/LPN/APRN) Aesthetician Laser Tech Other Please Enter Other Personnel That Need Coverage:(Required)Are You A New Startup?(Required) Yes No Estimated Date Practice Is Open To The Public:(Required) MM slash DD slash YYYY How Far Along Are You?(Required) Business Plan Is Not Ready, I'm Not Ready Business Plan Is Ready, Business Is Not Setup To Operate Business Is Ready To Operate How Far Along Are You?(Required) No Location Yet, Pending Lease Lease Executed, Business Not Ready To Operate Business Ready To Operate, Acquirring Personnel We Are Almost Ready To Open Do You Currently Provide Or Plan On Providing Any Type of Medical Spa / Aesthetic Type Services Such As Weight Loss, BHRT, PRP, Fillers/Injectables, IV Therapy, etc.?(Required) Yes No What Types Of Services Do You Provide Or Plan On Providing? (Check All That Apply)(Required) Fillers/Injectables IV Therapy BHRT (No Pellet Insertion) BHRT (Pellet Insertion) Weight Loss PRP Ketamine Chemical Peels Stem Cells Other What Types Of Services Do You Provide Or Plan On Providing? (Check All That Apply)(Required) Fillers/Injectables IV Therapy BHRT (No Pellet Insertion) BHRT (Pellet Insertion) Weight Loss PRP Ketamine Chemical Peels Stem Cells Other Please Enter Other Services You Provide Or Plan On Providing Here:(Required)Please Enter Other Services You Provide Or Plan On Providing Here:(Required)Do You Provide Medical Cannabis Evaluations?(Required) Yes No Do You Plan On Adding More Services To Your Practice Other Than IV Therapy Within The First Year?(Required) Yes No Do You Plan On Adding More Services To Your Practice Other Than Fillers/Injectables Within The First Year?(Required) Yes No What State(s) Is Your Business Located?(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDo You Estimate A Revenue Greater Than $50,000 For The Next 12 Months?(Required) Yes No Would You Like To Receive An Estimate Based On The Info You Provided Before Moving Forward With A Full Application? (To Receive An Accurate Detailed Quote A Completed Application Is Necessary)(Required) Yes, It Would Help Me Budget Appropriately No Time To Waste, Let's Get Right Into The Application Please! Estimated Policy Cost(Required) I understand this information is based on WMPG's annual national average & has not been audited and isn't based on credentialing my business.
