The following client intake forms are provided by Lloyds of London for your convenience; seek legal counsel before using these or any other legal documents in your business.

CLIENT INTAKE FORMS

Injectables

(Botox, Dermal, Meso)

Consents

Injectables (Vitamin)

Consents

Medispa Services

Consents

Medical History

Aftercare

Laser and IPL

Consents

Medical History

Aftercare

(from our London broker) Be advised that the consent forms attached are samples for the informational benefit of our customers. We encourage that these be reviewed by your legal counsel. In no event will (Marine Agency, its underwriters) or employees be liable to any party for any consequential damages resulting from reliance on the consent forms within, including, without limitation, loss profits, damage or expense incurred by any use the reader may choose to make of these consent forms. Said consequential damages include direct, indirect, special or other consequential damages.


The printable insurance application materials above require the free Adobe Reader.

Our Insurance Products

Contact Us

Maplewood NJ 07040

191 Maplewood Ave, Maplewood NJ 07040

Local: 973-763-4711

Toll-Free: 800-35-MARINE (800-356-2746)

Hours

9 AM - 5 PM , Monday - Thursday;

9 AM - 4 PM, Friday

Whitehouse Station NJ 08889

422 US Hwy 22 W, Unit 7, Whitehouse Station NJ 08889

Local: 908-838-9762

Toll-Free: 84-INSURE-NJ (844-678-7365)

Hours

9 AM - 5 PM , Monday - Thursday;

9 AM - 4 PM, Friday