PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR
INDIVIDUAL ALLIED HEALTHCARE PROFESSIONALS
Skip Navigation LinksSelect your status as an allied healthcare professional:
If you are both employed & self-employed, please select self-employed as your status


State of Residence:How many hours do you work per week?How many years experience do you have relevant to your profession?


Are you a military veteran that has completed a tour of active duty?
Please select all occupations for which you are requesting coverage. If you are a student, and do not currently hold a healthcare license or certification, please select your primary area of study.













Requested Effective Date of Coverage:Application # 5919308