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Temporary Course Coverage Application

Dentist Personal Information

Temporary coverage is offered for dentists coming to Utah for a course.
Dentists need to be in good standing within their own practicing state to qualify.


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. If, during the process of defending a claim, we found you had misrepresented any part of this application, we could deny coverage to you and you would be exposed to the entire cost of the lawsuit. Therefore, if any aspect of this application causes you to have questions, or gets into an area which you may feel is undefined or has complicating factors, please call us at 801-262-0200 and an agent will be happy to guide you through the application process over the phone.

Street Address

Maximum file size: 516MB

Have you had any malpractice claims?

Maximum file size: 516MB