CALCULATE YOUR SAVINGS 1 Contact Information2 Details Information First Name*Last NameEmail* Mobile Number*Date of Birth* Address StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State AgeAge30-3536-4041-4546-5051-5556-6061-6566-70Medical Specialty*Medical SpecialtyAllergistAnesthesiologistsAnesthetistCardiologists - Non InvasiveCardiologists - InvasiveCardiovascular SurgeonsCritical Care PhysicianEndodontist, Orthodontist, Periodontist, Prosthodontists, Pediatric DentistsOral and Maxillofacial SurgeonsOther DentistsDermatologistElectrophysiologistEmergency Room PhysiciansEndocrinologistsFamily Practice PhysiciansGastroenterologistsGenetic PhysiciansGeneral SurgeonGerontologistHemaongologistsHematologistsHospitalistInternistsInternal MedicineNeonatologistsNephrologistsNeurologistNeurosurgeonNurse Practitioner - degreedObstetrics and GynecologyGynecologist onlyOncologistsOphthalmologists, M.D.OptometristsOrthopedic SurgeonsOtolaryngologists E.N.TR.N. with office duties onlyPathologistsPediatriciansPerfusionistsPhysiatristPhysicians - General (MD)Physician's AssistantProctologistPulmonary/Respiratory MD SpecialistsPsychiatrist, M.D.Psychologist, PHDPsychologist, Master's DegreeRadiologist - Non InvasiveRadiologist - Any Invasive/Interventional proceduresRheumatologistsSports Medicine Physicians - non surgicalSports Medicine Physicians - with surgical dutiesSurgeonsRespiratoryVascular SurgeonsUrologistVeterinarians – DVM.Veterinarians – Large AnimalsOther Not ListedBenefit Amount ($)*Benefit Amount ($)$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000$12,000$13,000$14,000$15,000$16,000$17,000Sex*FemaleMaleNEXT >>> Regular Monthly Premium - The Doctor Disability Shop Monthly Discount - Monthly / - Annual The Doctor Disability Shop Discounted Monthly Premium - Quotes are for illustrative purposes only. Rates are based on your age, sex, medical specialty, plan options/riders, and geographical location. Rates are based on carrier financial and medical underwriting approval.
