ProAssurance

Applications for Prospective Clients

Find below medical professional liability insurance applications for physicians, paramedical and allied healthcare professionals, and hospitals and facilities. Dental professional liability applications are on the DentistCare website; select the 'How to Apply' menu item and then find your state in the drop box. Applications for the Ob-Gyn Risk Alliance (OBRA) are posted to OBRA's website; select the 'How to Apply' menu item and then find your state in the drop box. 

Completed applications can be emailed to our Service Center using Submissions@ProAssurance.com. For more information please email Information@ProAssurance.com or call 800.282.6242.

Those seeking renewal applications can find then on the Renewal Applications page.

Physicians

Universal Fraud Warning |
2 pages • 8.5 x 11 in • 87 KB
Alabama |
10 pages • 8.5 x 11 in • 544 KB
Arizona |
9 pages • 8.5 x 11 in • 433 KB
Arkansas |
9 pages • 8.5 x 11 in • 433 KB
Colorado |
9 pages • 8.5 x 11 in • 433 KB
Connecticut |
9 pages • 8.5 x 11 in • 422 KB
Delaware |
9 pages • 8.5 x 11 in • 421 KB
District of Columbia |
9 pages • 8.5 x 11 in • 422 KB
Florida |
9 pages • 8.5 x 11 in • 416 KB
Georgia |
9 pages • 8.5 x 11 in • 433 KB
Idaho |
9 pages • 8.5 x 11 in • 433 KB
Illinois |
9 pages • 8.5 x 11 in • 421 KB
Indiana |
9 pages • 8.5 x 11 in • 422 KB
Iowa |
9 pages • 8.5 x 11 in • 422 KB
Kansas |
9 pages • 8.5 x 11 in • 433 KB
Kentucky |
9 pages • 8.5 x 11 in • 421 KB
Maine |
9 pages • 8.5 x 11 in • 422 KB
Maryland |
9 pages • 8.5 x 11 in • 422 KB
Michigan |
9 pages • 8.5 x 11 in • 421 KB
Minnesota |
9 pages • 8.5 x 11 in • 422 KB
Mississippi |
9 pages • 8.5 x 11 in • 422 KB
Missouri |
9 pages • 8.5 x 11 in • 420 KB
Montana |
9 pages • 8.5 x 11 in • 422 KB
Nebraska |
9 pages • 8.5 x 11 in • 422 KB
Nevada |
9 pages • 8.5 x 11 in • 421 KB
New Hampshire |
9 pages • 8.5 x 11 in • 422 KB
New Jersey |
9 pages • 8.5 x 11 in • 421 KB
New York |
9 pages • 8.5 x 11 in • 435 KB
North Carolina |
9 pages • 8.5 x 11 in • 422 KB
Ohio |
9 pages • 8.5 x 11 in • 422 KB
Oklahoma |
9 pages • 8.5 x 11 in • 433 KB
Oregon |
9 pages • 8.5 x 11 in • 433 KB
Pennsylvania |
9 pages • 8.5 x 11 in • 421 KB
South Carolina |
9 pages • 8.5 x 11 in • 433 KB
South Dakota |
9 pages • 8.5 x 11 in • 422 KB
Tennessee |
9 pages • 8.5 x 11 in • 433 KB
Texas |
9 pages • 8.5 x 11 in • 433 KB
Utah |
9 pages • 8.5 x 11 in • 433 KB
Vermont |
9 pages • 8.5 x 11 in • 422 KB
Virginia |
9 pages • 8.5 x 11 in • 422 KB
Washington |
9 pages • 8.5 x 11 in • 433 KB
West Virginia |
9 pages • 8.5 x 11 in • 433 KB
Wisconsin - Claims-Made |
9 pages • 8.5 x 11 in • 421 KB
Wisconsin - Occurrence |
9 pages • 8.5 x 11 in • 424 KB
Wyoming |
9 pages • 8.5 x 11 in • 433 KB

Physician Corporations

Universal Fraud Warning |
2 pages • 8.5 x 11 in • 87 KB
Alabama |
5 pages • 8.5 x 11 in • 342 KB
Arizona |
4 pages • 8.5 x 11 in • 228 KB
Arkansas |
4 pages • 8.5 x 11 in • 228 KB
Colorado |
4 pages • 8.5 x 11 in • 228 KB
Connecticut |
4 pages • 8.5 x 11 in • 194 KB
Delaware |
4 pages • 8.5 x 11 in • 193 KB
District of Columbia |
4 pages • 8.5 x 11 in • 194 KB
Florida |
4 pages • 8.5 x 11 in • 196 KB
Georgia |
4 pages • 8.5 x 11 in • 228 KB
Idaho |
4 pages • 8.5 x 11 in • 228 KB
Illinois |
4 pages • 8.5 x 11 in • 193 KB
Indiana |
4 pages • 8.5 x 11 in • 194 KB
Iowa |
4 pages • 8.5 x 11 in • 224 KB
Kansas |
4 pages • 8.5 x 11 in • 228 KB
Kentucky |
4 pages • 8.5 x 11 in • 193 KB
Maine |
4 pages • 8.5 x 11 in • 194 KB
Maryland |
4 pages • 8.5 x 11 in • 194 KB
Michigan |
4 pages • 8.5 x 11 in • 193 KB
Minnesota |
4 pages • 8.5 x 11 in • 224 KB
Mississippi |
4 pages • 8.5 x 11 in • 224 KB
Missouri |
4 pages • 8.5 x 11 in • 189 KB
Montana |
4 pages • 8.5 x 11 in • 194 KB
Nebraska |
4 pages • 8.5 x 11 in • 224 KB
Nevada |
4 pages • 8.5 x 11 in • 191 KB
New Hampshire |
4 pages • 8.5 x 11 in • 194 KB
New Jersey |
4 pages • 8.5 x 11 in • 193 KB
New York |
4 pages • 8.5 x 11 in • 189 KB
North Carolina |
4 pages • 8.5 x 11 in • 194 KB
Ohio |
4 pages • 8.5 x 11 in • 194 KB
Oklahoma |
4 pages • 8.5 x 11 in • 228 KB
Oregon |
4 pages • 8.5 x 11 in • 228 KB
Pennsylvania |
4 pages • 8.5 x 11 in • 193 KB
South Carolina |
4 pages • 8.5 x 11 in • 228 KB
South Dakota |
4 pages • 8.5 x 11 in • 224 KB
Tennessee |
4 pages • 8.5 x 11 in • 228 KB
Texas |
4 pages • 8.5 x 11 in • 228 KB
Utah |
4 pages • 8.5 x 11 in • 228 KB
Vermont |
4 pages • 8.5 x 11 in • 194 KB
Virginia |
4 pages • 8.5 x 11 in • 194 KB
Washington |
4 pages • 8.5 x 11 in • 228 KB
West Virginia |
4 pages • 8.5 x 11 in • 228 KB
Wisconsin |
4 pages • 8.5 x 11 in • 190 KB
Wyoming |
4 pages • 8.5 x 11 in • 228 KB

Physician Supplemental

Practice Hours Supplemental Application |
1 page • 8.5 x 11 in • 159 KB

Paramedicals

Universal Fraud Warning |
2 pages • 8.5 x 11 in • 87 KB
Alabama |
4 pages • 8.5 x 11 in • 216 KB
Arizona |
3 pages • 8.5 x 11 in • 193 KB
Arkansas |
3 pages • 8.5 x 11 in • 193 KB
Colorado |
3 pages • 8.5 x 11 in • 193 KB
Connecticut |
3 pages • 8.5 x 11 in • 179 KB
Delaware |
4 pages • 8.5 x 11 in • 163 KB
District of Columbia |
3 pages • 8.5 x 11 in • 179 KB
Florida |
3 pages • 8.5 x 11 in • 163 KB
Georgia |
3 pages • 8.5 x 11 in • 193 KB
Idaho |
3 pages • 8.5 x 11 in • 193 KB
Illinois |
3 pages • 8.5 x 11 in • 163 KB
Indiana |
3 pages • 8.5 x 11 in • 179 KB
Iowa |
3 pages • 8.5 x 11 in • 172 KB
Kansas |
3 pages • 8.5 x 11 in • 193 KB
Kentucky |
3 pages • 8.5 x 11 in • 163 KB
Maine |
3 pages • 8.5 x 11 in • 179 KB
Maryland |
3 pages • 8.5 x 11 in • 179 KB
Michigan |
3 pages • 8.5 x 11 in • 163 KB
Minnesota |
3 pages • 8.5 x 11 in • 172 KB
Mississippi |
3 pages • 8.5 x 11 in • 172 KB
Missouri |
3 pages • 8.5 x 11 in • 193 KB
Montana |
3 pages • 8.5 x 11 in • 179 KB
Nebraska |
3 pages • 8.5 x 11 in • 172 KB
Nevada |
3 pages • 8.5 x 11 in • 224 KB
New Hampshire |
3 pages • 8.5 x 11 in • 179 KB
New Jersey |
3 pages • 8.5 x 11 in • 163 KB
New York |
3 pages • 8.5 x 11 in • 188 KB
North Carolina |
3 pages • 8.5 x 11 in • 179 KB
Ohio |
3 pages • 8.5 x 11 in • 179 KB
Oklahoma |
3 pages • 8.5 x 11 in • 193 KB
Oregon |
3 pages • 8.5 x 11 in • 193 KB
Pennsylvania |
3 pages • 8.5 x 11 in • 163 KB
South Carolina |
3 pages • 8.5 x 11 in • 193 KB
South Dakota |
3 pages • 8.5 x 11 in • 172 KB
Tennessee |
3 pages • 8.5 x 11 in • 193 KB
Texas |
3 pages • 8.5 x 11 in • 193 KB
Utah |
3 pages • 8.5 x 11 in • 193 KB
Vermont |
3 pages • 8.5 x 11 in • 179 KB
Virginia |
3 pages • 8.5 x 11 in • 179 KB
Washington |
3 pages • 8.5 x 11 in • 193 KB
West Virginia |
3 pages • 8.5 x 11 in • 193 KB
Wisconsin |
3 pages • 8.5 x 11 in • 172 KB
Wyoming |
3 pages • 8.5 x 11 in • 193 KB

Allied Healthcare Professionals

Universal Fraud Warning |
2 pages • 8.5 x 11 in • 87 KB
Illinois |
6 pages • 8.5 x 11 in • 171 KB
Michigan |
6 pages • 8.5 x 11 in • 171 KB
New Jersey |
6 pages • 8.5 x 11 in • 171 KB

Hospitals and Healthcare Systems

Alabama
9 documents
Arkansas
9 documents
Delaware
9 documents
District of Columbia
9 documents
Georgia
9 documents
Illinois
9 documents
Indiana
9 documents
Iowa
9 documents
Kansas
9 documents
Kentucky
9 documents
Maryland
9 documents
Michigan
9 documents
Minnesota
9 documents
Missouri
9 documents
Nebraska
9 documents
Nevada
9 documents
New York
9 documents
North Carolina
9 documents
Ohio
9 documents
Oklahoma
9 documents
South Carolina
9 documents
South Dakota
9 documents
Tennessee
9 documents
Texas
9 documents
Utah
9 documents
Virginia
9 documents
Wisconsin
9 documents
Wyoming
9 documents

Multi-State Organizations

National Healthcare Application - Alabama |
10 pages • 8.5 x 11 in • 594 KB
National Healthcare Application - All Other States |
9 pages • 8.5 x 11 in • 409 KB
National Healthcare Application - Missouri |
9 pages • 8.5 x 11 in • 522 KB
National Healthcare Application - Nevada |
9 pages • 8.5 x 11 in • 544 KB
National Healthcare Application - New Jersey |
10 pages • 8.5 x 11 in • 467 KB
National Healthcare Application - Texas |
9 pages • 8.5 x 11 in • 403 KB
National Healthcare Application - Virginia |
9 pages • 8.5 x 11 in • 414 KB
National Healthcare Application - Wisconsin |
9 pages • 8.5 x 11 in • 412 KB
Universal Fraud Warning |
2 pages • 8.5 x 11 in • 87 KB