Section 1: Contact

1. Name of Organisation(Required)

2. Submitter name(Required)

3. Job Title(Required)

4. Address line 1(Required)

Address line 2

Town/City

County

Postcode(Required)

5. Email(Required)

Section 2: General

6. What was your total income for the last full financial year?(Required)

6a. What is your anticipated current income?(Required)

7. What limit of indemnity do you require?(Required)

Section 3: Staff

8. How many staff members work for you? (Total, including part time)(Required)

Please specify the split of these staff members below. The numbers given in the splits below should total the figure given above.

9. Non clinical / administrative / unqualified - number of staff

9a. Non clinical / administrative / unqualified - number of hours per week

10. Employed dispensing opticians (including CLO / MECS) - number of staff

10a. Employed dispensing opticians (including CLO / MECS) - total number of hours per week for all staff

11. Self employed dispensing opticians (including CLO / MECS) - number of staff

11a. Self employed dispensing opticians (including CLO / MECS) - number of hours per week

12. Employed optometrists - number of staff

12a. Employed optometrists - number of hours per week

13. Self employed optometrists - number of staff

13a. Self employed optometrists - number of hours per week

Section 4: Previous claims, services and individuals

It is a condition of the policy that all employed and self employed dispensing opticians and optometrists hold their own personal professional indemnity insurance.

14. Have you or any of the directors and/or partners have never been made bankrupt or insolvent, been convicted of or charged with a criminal offence?(Required)

15. Do you offer any services that fall outside the scope of a Dispensing Optician/Optometrist. If you are unsure whether a service you provide is within the scope of practice of a Dispensing Optician, then please contact ABDO. If you are unsure whether a service you provide is within the scope of practice of an Optometrist then please contact the AOP or the College of Optometrists.(Required)

16. Have you had any previous medical malpractice claims? If so, what happened?(Required)

17. Any other information you wish to provide.

Section 1: Contact

Section 2: General

Section 3: Staff

Section 4: Previous claims, services and individuals

Contact Us

Find us