Medical Liability Insurance |
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Asset Protection for Professionals |
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Applications To provide convenience to current and potential clients, this page contains applications for various professional liability insurance programs. A checklist precedes each application and includes instructions on additional items required for a complete application. YOU MUST SUBMIT THESE APPLICATIONS TO US VIA FAX (704-927-5981) OR EMAIL TO EDKUHN60@HOTMAIL.COM CALL YOUR PROFESSIONAL LIABILITY SOLUTIONS AGENT FOR PERSONAL ASSISTANCE. (These programs are in Adobe Acrobat. If you do not have Adobe Acrobat on your computer, click here to download.) MEDICAL SPA / AESTHETIC PRACTICE / ANTI-AGING CLINICS For a quick premium indication, complete the one-page application via the link below: Medical Spa / Aesthetic Insurance Program Indication Application - covers spa, staff and physician performing direct patient care. (For indication purposes only. Firm Quotes are subject to full underwriting.) INDIVIDUAL PHYSICIAN For premium quotes, simply complete, sign and date application via the link below: Individual Physician Application - covers individual physician or surgeon
GROUP OF PHYSICIANS/SURGEONS CONTACT PLS TO SPEAK DIRECTLY TO A REPRESENTATIVE HEALTHCARE FACILITY (i.e. Surgery Centers, Laboratories, Dialysis Centers, Cancer Care Centers, Imaging Centers, etc.) For premium quotes, complete the applicaiton via the link below: Clinics (Entity) Application - covers the healthcare facility and can include coverage for staff members CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) For premium quotes, complete, sign and date the application via the link below: CRNA Application - covers the Nurse Anesthetist for procedures performed
LOCUM TENENS AND PERMANENT PLACEMENT STAFFING For premium quotes, complete, sign and date application via link below: Locum Tenens and Contract Staffing Application - covers the company and the individual placements for work performed
FAX YOUR COMPLETED, SIGNED AND DATED APPLICATIONS, ALONG WITH ADDITIONAL MATERIALS REQUIRED TO 704-927-5981 OR EMAIL TO EDKUHN60@HOTMAIL.COM
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