Renewal Questions
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Professional Liability Insurance Renewal Form

Dentist Personal Information

Dear Insured,
Welcome back! Let's make sure all of your information is current. Please review the following.

In order to have assurance that you will have coverage for any liability claims which may come against you, it is crucial that you answer these questions honestly, accurately, and thoroughly. Therefore, if any aspect of this application creates a question, please call us at 801-262-0200 and an agent will be happy to guide you through the application process over the phone.

Welcome to PIE!


Your name can not be changed online, it should be auto-filled. Please contact PIE at (801)262-0200 if this field is blank, or if you need to change your name on record.

Your coverage commencement date can not be changed, it should be auto-filled. Please contact PIE at (801)262-0200 if this field is blank. This is important to calculate your premiums correctly.
If you do not have your policy number (Provided on your renewal notice) Please contact PIE at (801)262-0200 and they can provide you with this information.
Office Address
Office Address
Type of Practice or Certified Specialty
Do you ever have an anesthesiologist perform deep sedation in your office, or do you ever perform dentistry on a patient under deep sedation in a hospital setting?
Choose your coverage limit
Do you prefer to pay annually, semiannually, or quarterly?
Pay annually and save! Quarterly pays 10% more, Semiannually pays 8% more.