Cybersecurity Assessment Form

Assessor Information

Assessor's Name: Assessor's Email:

Practice Information

Practice Name: Address: City: State/Province: Zip/Postal Code: Country: Website (e.g., example.com):

Contact Information

Contact Person Full Name: Phone Number: Email Address:

Cyber Insurance Information

Do you have Cyber Insurance?
Insurance Provider: Coverage Amount: Insurance Expiration Date: Have you experienced a cyber incident in the last 3 years?
Incident Details:

Security Controls

Do you perform Automated Patch Management?
Do you require MFA for all remote access?
Do you require MFA for all admin access?
Do you require MFA for all email access?
Do you have a strong password policy?
Do you remove dormant accounts after 90 days?
Do you have a Next Gen AV / EDR Solution?
Do you have Email / Spam Filtering in place?
Do you have a Backup (including offline/cloud with data recovery testing)?
Do you have encryption in transit and on the endpoints?