Lines of coverage available:

  • Professional Liability
  • General Liability
  • Sexual Abuse and Molestation Coverage

Here is a partial list of professions for which you can you can use this application for insurance:

  • Athletic training
  • Audiology
  • Cardiovascular perfusion technology

  • Cytotechnology

  • Day Spa

  • Dental hygiene

  • Diagnostic medical sonography

  • Dietetics

  • Emergency medical sciences

  • Health administration

  • Health information management

  • Home Health Aide

  • Massage Therapist

  • Medical technology

  • Medi Spa

  • Nuclear medicine technology

  • Occupational therapy

  • Physical therapy

  • Physician assistant

  • Radiation therapy technology

  • Radiography

  • Rehabilitation counseling

  • Respiratory therapy

  • Respiratory therapy technology

  • Senior Assistant

  • Speech-language pathology

  • If you do not see something on the list, just contact us to ask.

The application below can be used for multiple carriers.

You will see that this application already has most of the check boxes completed so that this application can serve as a template. They are checked to indicate what is required to qualify for this quote with many carriers and to make the process more convenient for you.  Please make sure that the application is correct and make any changes that are necessary.  It is provided as a guideline so that you can see the requirements.  If the pre-checked boxes are not correct, please make sure to update them and we can submit this to additional markets. Disclaimer: It is your responsibility to confirm with the applicant that the questions are answered correctly.

If you find that this application does not meet the needs of your application, please contact us and we can send an alternative application that may be available.

Submit the application online here: