PLEASE COMPLETE THE SURVEY BELOW
The information helps Veterinarian Insurance better serve its clients.
Upon your submission of the survey form, we will send you
a checklist for insurance protection, so you can lower your financial risk.
Email
What is your gender?
Select...
Female
Male
What is your age?
Select...
60+ years of age
50 to 59 years of age
40 to 49 years of age
30 to 39 years of age
20 to 29 years of age
< 20 years of age
What is your marital status?
Select...
Single or never married
Married or domestic partnership
Divorced
Separated
Widowed
How many dependents do you have including yourself?
Select...
1
2
3
4
5
>5
What Is the number of full time employees (30+ hrs per week
) that work in your veterinary clinic?
Select...
0
1-5
6-10
11-20
21-50
51-100
101-1,000
> 1,000
How confident are you that your professional liability insurance adequately covers errors made by you?
Select...
Lowly confident
Not confident
Neither confident or not confident
Confident
Highly confident
I do NOT have professional liability insurance
Last time your professional liability insurance was reviewed?
Select...
2018
2017
2016
2015
2014
2013
2012
Before 2012
How confident are you that you have enough property insurance for your business if damaged, destroyed or lost?
Select...
Lowly confident
Not confident
Neither confident or not confident
Confident
Highly confident
I do NOT have property insurance
Last time your business property insurance was reviewed?
Select...
2018
2017
2016
2015
2014
2013
2012
Before 2012
Does your company have a group health insurance plan?
Select...
Yes
No
How confident are you that you have enough disability insurance to protect against loss of income if you got sick or injured and were no longer able to work as a veterinarian?
Select...
Lowly confident
Not confident
Neither confident or not confident
Confident
Highly confident
I do NOT have disability insurance
How much life insurance do you have?
Select...
$0
$1 to $250,000
$250,001 to $500,000
$501,000 to $750,000
$750,001 to $1,000,000
> $1,000,000
How confident are you that you have enough life insurance to protect your family if you were to suddenly die?
Select...
Lowly confident
Not confident
Neither confident or not confident
Confident
Highly confident
I do NOT have life insurance
Number of brokers you currently have for ALL insurance plans for yourself, family, veterinary practice and business?
Select...
0
1
2
3
4
5
> 5
Interest in having 1 broker that specializes in veterinarian insurance to manage ALL your plans that protect you, your family and business against financial risk?
Select...
Very interested
Interested
Neither interested or not interested
Not interested
Not very interested
Did you know Veterinarian Insurance pledges 5% of all commissions to charities that help animal and environmental causes like Veterinarian without borders?
Select...
Yes
No
Company
Business State
SMS Number
Office Phone
Birthday
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