D.S.G. Douglas S. Gordon Insurance Services

F.A.Q.

Home > Medical > Quick Quote

PPG MED-MAL Program Quick Quote
Please provide the following information and one of
our representatives will be in touch with you shortly.


Practice Manager's Information (If Applicable)
Name
Address
City	State	Zip
Phone	E-mail


General Practice Information
Phone Number
Fax Number
State License Number
DEA Number
PPG Member I.D. Number
Physician's / Dentist's Specialty
Subspecialty (if any)
Surgery Classification (**Defined Below)
Work Hour Classification
Number of Hours Per Week
Current Insurance Company
Current Premium
Policy Expiration Date
Coverage Form
Retro Date
Years in Practice
Policy Limits of Liability

Have you ever been sued or had a claim against you for medical liability?	Yes No
If you answered "yes" above please "click here". (This will open a separate form in a new window)

Definitions of Surgery No Surgery-permits incision of boils and superficial abscesses, or suturing of skin or superficial fascia. Minor surgery- and/or assisting in major surgery on own, includes minor obstetrical procedures, D&C's, Vasectomies, or any minor operation done under anesthesia. Major surgery**-includes operations done under general anesthesia, including tonsillectomies, Adenoidectomies, Caesarian Sections, and assisting in major surgery or patients other than your own. ( The term major surgery does not include D&C's)