Hospitalist Insurance Quote Request Step 1 of 3 33% Entity Type* Individual Group Staffing Company Company/Group Name* Number of Doctors in Group*1-55-1010-2020 or moreSpecialty* Please enter your specialtyAre you a member of the Society of Hospital Medicine (SHM) Yes No County of Practice* Enter the county where most of the work is performed Current Malpractice Insurance Carrier* Policy Expiration Date* MM slash DD slash YYYY Group Claim History Last 5 Years* No Prior Coverage Zero Claims 1 or more >2 Claims Physicians or Groups With No Claims are Eligible for Discounts Individual Claim History Last 5 Years* No Coverage Zero Claims 1-2 Claims > 2 Claims Do You Practice Full-Time* Yes No First Name* Enter first nameLast Name* Enter last namePhysician's Full Name: Best Email Contact:* Most Convenient Phone Number:*Current Annual Premium* Current Policy Type*Claims MadeOccuranceNot SureHow many patients do you see each week on average? Δ
