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 (704-973-9605)
Email:  apply@pls-medmal.com

CALL YOUR PROFESSIONAL LIABILITY SOLUTIONS AGENT FOR PERSONAL ASSISTANCE.

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, bindable quotes are subject to a full completed application.)

INDIVIDUAL PHYSICIAN

For premium quotes, simply complete, sign, date and return application with a copy of your current CV:

Individual Physician Application – covers individual physician or surgeon

GROUP OF PHYSICIANS/SURGEONS

CONTACT Professional Liability Solutions 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

ALLIED HEALTHCARE PROVIDERS (CRNA, PA, NP, RN, etc)

For premium quotes, complete, sign and date the application via the link below:

CRNA Application – covers the Nurse Anesthetist for procedures performed

For premium quotes…. Healthcare Professional Application– covers the provider for procedures performed

FAX (704-973-9605)
Email:  apply@pls-medmal.com

Your Insurance Starts Here

Fill out the form below

Or call — 800-372-3268

“We switched to working with Professional Liability Solutions in 2003 and have been happy ever since. Not only did you help us step-by-step through the renewal process, you knew exactly what we wanted and were very understanding of our needs. You have been very thorough, caring and knowledgeable since our introduction. I would recommend Professional Liability Solutions to anyone.”

Diana B

Texas

Experience. Knowledge. Commitment.

Contact us to get your free quote