APPLICATION FOR PHYSICIAN’S AND SURGEONS’ PROFESSIONAL LIABILITY INSURANCE

Online Instructions:  Please note that the online application will take an estimated 20 to 30 minutes to complete. We recommend that you create an account (link on the next page) and please save often. You may return to complete your application for 30 days.

ONLINE APPLICATION CLICK HERE
(Form may take up to 20 /40 secs to load depending on your internet speed)


Mail / Fax : If you would like to print and fill out this application by hand click here. and mail it in please click here for download. When completed mail to : 110 Veterans Boulevard, Suite 360, Metairie, Louisiana 70005-4930 or FAX to  (504) 836-2860

To access Application please click here.


Questions? Feel free to call us today at (504) 834-6240