Insurance Broker
Medical Professional Liability
1-877-245-5887

Applications

We provide malpractice insurance in the following states
Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin, Wyoming.

Prior to completing your application, please first verify that your state is on the list of states we serve. Complete your application and return to us by either fax (310-796-9054) or email (scan of signed application). Do not hesitate to call us if you have any questions regarding your application.

We also accept recently completed applications from different insurance companies or brokers.

 Physicians and Surgeons - Individual  Application
 Physicians and Surgeons - Corporation  Application
 Dentists, Oral Surgeons, Orthodontists - Individual  Application
 Dentists, Oral Surgeons, Orthodontists - Corporation  Application
 Chiropractors  Application
 Audiologists, Dieticians, Nutritionists, Music Therapists,
 Occupational Therapists, Speech Pathologists/Therapists and
 Opticians
 Application
 All Other Health Care Practitioners  Application
 Surgery Centers  Application
 Hospitals  Application
 Urgent Care Centers  Application
 Miscellaneous Facilities (Non Hospital)  Application
 Laboratories (Pathology, Microbiology, Biochemistry, Research)  Application
 Imaging Centers  Application
 Blood/Organ/Tissue Banks  Application
 Rehabilitation Facilities: Physical/Occupational/Cardiac  Application
 Behavioral Health Facilities  Application
 Cancer Treatment Centers  Application
 Dialysis Centers  Application
 Medical Spa Facilities (Medi-Spas)  Application
 Home Health / Medical Staffing  Application
 Nursing Homes, Retirement Centers, Home Health Care  Call Us
 Mental Health Counseling Services  Call Us
 Ambulance Services  Call Us
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