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.
FAX (704-973-9605)
Email: apply@pls-medmal.com
CALL YOUR PROFESSIONAL LIABILITY SOLUTIONS AGENT FOR PERSONAL ASSISTANCE. 800-372-3268
MEDICAL SPA / AESTHETIC PRACTICE / ANTI-AGING CLINICS
For premium quotes, simply complete, sign and date the application below. You can return it to us via fax (704-973-9605) or email (apply@pls-medmal.com)
Medical Spa / Aesthetic Insurance Program Indication Application – covers spa, staff and physician performing direct patient care. (For indication purposes only. Firm, bindable quotes are subject to a full completed application.)
INDIVIDUAL PHYSICIAN
For premium quotes, simply complete, sign and date the application below. You can return it to us via fax (704-973-9605) or email (apply@pls-medmal.com)
Individual Physician Application – covers individual physician or surgeon
GROUP OF PHYSICIANS/SURGEONS
HEALTHCARE FACILITY (i.e. Surgery Centers, Laboratories, Dialysis Centers, Cancer Care Centers, Imaging Centers, etc.)
For premium quotes, simply complete, sign and date the application below. You can return it to us via fax (704-973-9605) or email (apply@pls-medmal.com)
Clinics (Entity) Application – covers the healthcare facility and can include coverage for staff members
ALLIED HEALTHCARE PROVIDERS (CRNA, PA, NP, RN, etc)
For premium quotes, simply complete, sign and date the application below. You can return it to us via fax (704-973-9605) or email (apply@pls-medmal.com)
CRNA Application – covers the Nurse Anesthetist for procedures performed
For premium quotes, simply complete, sign and date the application below. You can return it to us via fax (704-973-9605) or email (apply@pls-medmal.com)
FAX (704-973-9605)
Email: apply@pls-medmal.com
Diana B
“Thanks for all of your help Angela…you have always made this process so easy for us.”
Chris R
South Carolina