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Fill in your contact and practice details below and we’ll take care of the rest. A member of our team will review your information and be in touch within the next business day to discuss a quote tailored to your needs.

Prefer to speak to someone? Call us on 1800 777 156 – we’re here to help.

Title

First name

Last name

Practice/Hospital Name

Suburb

State

Phone

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Policy Type

Select the option which best describes your circumstances

What type of medical practice do you undertake for which you require cover?

Primary Speciality

Do you require cover for the treatment of public patients?

Annual Gross Income

Average Sessions per Week

Date Started in Private Practice

Current Insurer

When would you like your insurance to commence

How did you hear about us?

Do you have any additional comments regarding your practice or insurance requirements?

Comments

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