MedSpa Quote - Marker Insurance
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MedSpa Quote

    Business Owners Questionnaire


    Business Name (dba):

    Street Address:

    City:

    Zip Code:

    State:

    County:

    Telephone:

    Email:

    Description of Business:

    Years in Business:

    Tax ID Number:

    Medical Director:

    Loss Information:

    Gross Sales:

     

    Med Spa Operations

    ACUPUNCTURE

    Current # of Procedures Annually:

    BOTOX

    Current # of Procedures Annually:

    CHELATION THERAPY

    Specify Type:

    CHEMICAL PEELS

    Specify Type:

    DAY SPA ACTIVITIES: WAXING, WRAPS, DERMOSONIC, EXFOLIATIONS, FACIALS, HAIR CARE, LASH EXTENSIONS, MAKE-UP APPLICATIONS, NAILS, REFLEXOLOGY, TANNING

    Current # of Procedures Annually:

    HAIR TRANSPLANT

    Specify Type:

    HERBAL OR VITAMIN SUPPLEMENTS OR REMEDIES OR IV and Gluteal injection

    Current # of Procedures Annually:

    HORMONE THERAPY/VITAMIN INJECTIONS

    Specify Type & Delivery Method:

    INJECTIONS/FILLERS, RESTYLANE AND JUVEDERM

    Current # of Procedures Annually:

    KYBELLA FOR RECOMMENDED USES ONLY

    Current # of Procedures Annually:

    LASER HAIR REMOVAL/ELECTROLYSIS

    Current # of Procedures Annually:

    LASER LIPOSUCTION (SMART LIPO)

    Current # of Procedures Annually:

    LASER SKIN TIGHTENING: VELASMOOTH (CELLULITE TREATMENT WITH RADIO FREQUENCY), THERMAGE, ENDERMOLOGIE

    Current # of Procedures Annually:

    LASER SKIN TREATMENT: TITAN, GENESIS, FRAXEL

    Current # of Procedures Annually:

    LIPOINJECTION/FAT TRANSFER

    Current # of Procedures Annually:

    LIPOSUCTION (REGULAR)

    Current # of Procedures Annually:

    LIPOSUCTION (TUMESCENT)

    Current # of Procedures Annually:

    MASSAGE

    Current # of Procedures Annually:

    MESOTHERAPY/LIPODISSOLVE

    Specify Type:

    MICRODERMABRASION

    Current # of Procedures Annually:

    MICROPIGMENTATION (PERMANENT MAKEUP)

    Current # of Procedures Annually:

    MINI FACELIFT

    Current # of Procedures Annually:

    PHOTO THERAPY: LEVULAN, PHOTO REJUVENATION (RPL), FOTO FACIALS

    Current # of Procedures Annually:

    PRP/PROLOTHERAPY

    Specify Type & Where Used:

    RADIOFREQUENCY FACE LIFT PROCEDURES

    Current # of Procedures Annually:

    SKIN TAG REMOVAL

    Current # of Procedures Annually:

    SCLEROTHERAPY

    Current # of Procedures Annually:

    TATTOO REMOVAL

    Specify Type:

    WEIGHT CONTROL MEDICATIONS

    Specify Type:

    OTHER

    Describe Procedure Type:

    OTHER

    Describe Procedure Type:

    OTHER

    Describe Procedure Type:
    OTHER

    Describe Procedure Type:

     

    Medical Staff

     

    Physician Name:

    Physician Name:

    Physician Name:

    Medical Professional (RN, Nurse, PA, SA) Name:

    Medical Professional (RN, Nurse, PA, SA) Name:

    Medical Professional (RN, Nurse, PA, SA) Name:

    Medical Professional (RN, Nurse, PA, SA) Name:

     

    Property Information

     

    Building

    Square Feet:

    Construction:

     

    Updates

    Roof:
    Electric:

    Alarm:

     

    Other occupants in building:

    Shutters Protection:

    Building/Additional & Alterations Limit:

    Content Limit:

    Additional Coverage:

    Additional Attachments:

     

    Disclaimer: Insurance coverage cannot be bound or changed via submission of any online form/application provided on this site or otherwise.No binder, insurance policy,change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly by a licensed agent.

    See our full list of coverage options and how we can help you today