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Bariatric Practice Profile Survey

To receive a non-binding premium indication, please fill out the form below and press the Send Request button.

Named Insured



Coverage

Surgical Practice Devoted to Following Surgical Activities

Please Indicate the approximate percentage of your total procedures each of the following represents:

Procedure

Indicate the number of the following bariatric procedures you perform on an annual basis


PROCEDURE TOTAL # OF LAPARASCOPIC TOTAL # OPEN

Press Send to receive a rate indication. For a full quote please press Send and also email a copy of your most recent 5 year loss run and current declarations page to forrest.pullen@mgis.com.