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Name

GMC number

Phone

E-mail

Date of birth

Date started private practice

Current provider

Current premium

No. of years with current provider

Required start date

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Coming years estimated gross private practice income

Coming years estimated gross Medico Legal income

Approximate number of procedures performed in the last year:

Approximate split between consultations and procedures performed in the last year:

Do you treat any elite/professional sports people or high profile (media, TV etc) patients?

Yes

Do you plan to cease practice or do you have any retirement plans (Private Practice, NHS or Medico Legal):

Yes

Have you ever been or are you currently subject to any complaints, claims, disciplinary investigations or circumstances which could lead to a claim, either in the UK or overseas:

Yes

Corporate Social Responsibility

Medical Malpractice Insurance

Medical Indemnity Insurance

Surgeon Indemnity Insurance

Primus Medical Indemnity Ltd
Lake View House,
Wilton Drive,
Warwick,
CV34 6RG.

Primus Medical Indemnity Ltd are Authorised and Regulated by the Financial Conduct Authority.
Primus Medical Indemnity Ltd are registered in England & Wales at Lake View House, Wilton Drive, Warwick, CV34 6RG
Companies House Registration Number 08966062
© 2014-2022 Primus Indemnity

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Your Practice

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Your Practice

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