Durable Medical Equipment (DME) Insurance Indication

You can use the secure online form below to request a premium indication. You can also download a copy of our full application to complete offline and fax to (925) 677-7401 or email to healthcare@polaris-ins.com. If you would also like an indication for a bond you can download our bond application. Contact one of our risk specialists at (925) 677-7400 if you have any questions or need additional assistance.

Durable Medical Equipment Application


Any Installation Work Performed

In the past five years has any claim or suit been made against the applicant or predecessor firms?

POLICY HISTORY (if currently insured):

1800 Sutter Street, Suite 777, Concord, CA 94520  |  Ph: 925.677.7400  |  Fx: 925.677.7401 | CA License #0D80810
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