Thank you for submitting your application!
Our underwriting team will promptly review it and will respond to you. If you have questions or need to speak to someone immediately, please call us at (888) 217-2779.
Or, Submit your documents to us using one of these methods:
Email it: Email your documents to Apply@PracticeProtection.com
Fax it: Fax your forms to (800) 240-9860
Mail it: Mail your forms to:
PracticeProtection Insurance Company
Attn: Underwriting Department
P.O. Box 600832
Saint Johns, FL 32260
Application Documents
As we mentioned on the Application, we will need a copy of the Declarations Page (face sheet) of your current policy. If you already submitted it to us, Thank You! If not, you can submit it to us however you prefer. Please see the various submission methods on the left side of this page.
Additional Documentation
If available, please submit a copy of your most recent Curriculum Vitae (CV). Please also submit any additional documentation as needed to best inform PracticeProtection of anything that would be useful in the underwriting of your application for insurance. Once again, you submit it to us however you prefer, Please see the various submission methods on the left side of this page.
Supplemental Forms
Supplemental Forms are only needed if they apply to you.
CLAIM SUPPLEMENT FORM – If you answered “Yes” to any of the questions regarding prior malpractice claims/incidents, prior potential claims/incidents, outstanding claims/incidents and/or potential claims/incidents, please fully explain each case by downloading and completing a Claim Supplement Form.
ENTITY SUPPLEMENT FORM – If you indicated that you want Separate Limits for an entity, please download and complete an Entity Supplement Form.
FACIAL COSMETIC PROCEDURE SUPPLEMENT FORM – If you indicated that you perform Cosmetic dermal procedures, please download and complete a Facial Cosmetic Procedure Supplement Form.