Fenton Green Insurance

Completing this online Proposal Form

Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Fenton Green, please ensure you check all information and make any necessary changes.

Business Details

Income Details

Total Annual Income

Employee Numbers

Number of practitioners (including yourself):

Are any of the above staff students?

Yes No

State

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Association

Are you a member of an association?

Yes No

Please select the practitioners primary association of which they belong to

Please Note: If you are obtaining health fund provider numbers through AMT, the minimum requirement for professional indemnity insurance is $2,000,000 and $10,000,000 for public liability

Do you authorise Fenton Green Pty Ltd, to provide your policy documents to the Association of Massage Therapists (AMT)?

Yes No

Please provide the Association name

Modalities

Yes

Do you perform any other activities other than below listed AMT Recognised Modalities?

Massage therapy (includes Therapeutic, Relaxation, Swedish, corporate, Indian Head massage)
Remedial/deep tissue massage (includes connective tissue, muscle energy techniques, myofascial release, trigger point, joint mobilisation, Onsen, Orthobionomy)
Taping (includes, functional, sports, Kinesio)
Stretch, strength, conditioning and movement therapy (including Pilates, Yoga, Wu Tao, Ai Chi, Alexander Technique, Qi Gong, Gyrotonics, Gyrokinesis, Spiral Dynamic, Rolf Movement, Yogalates)
Structural integration (includes Rolfing, Feldenkreis, Hellerwork, Functional, Anatomy Trains. KMI)
Lymphatic drainage (includes manual lymph drainage,)
Oriental massage (includes Shiatsu, Watsu, Zen Shiatsu, Tui Na, acupressure)
Thermotherapy (includes cold/hot stone massage, moxibustion)
Electrotherapy (includes ENAR, SCENAR, TENS, IFAS)

Reflexology
Bowen Therapy (includes Emmett Technique, neurostructural integration, fascial kinetics)
Instrument assisted soft tissue release (includes cupping, gua sha, RockBlades)
Aromatherapy
Somatic therapy (includes somatic therapy, somatic experiencing and somatic integration)
Dry Needling
Craniosacral therapy (includes craniofascial)
Infant massage
Oncology Massage
Pregnancy massage
Myotherapy
Pain Education
Mobilisation of the nervous system