• Home
  • New Business Applications

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 call 800-282-6242.

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

Physicians

Payment Plan Options |
1 page • 8.5 x 11 in • 116 KB
Universal Fraud Warning |
2 pages • 8.5 x 11 in • 61 KB
Alabama |
9 pages • 8.5 x 11 in • 479 KB
Alabama Arbitration Agreement |
1 page • 8.5 x 11 in • 160 KB
Arizona |
9 pages • 8.5 x 11 in • 543 KB
Arkansas |
9 pages • 8.5 x 11 in • 543 KB
Colorado |
9 pages • 8.5 x 11 in • 543 KB
Connecticut |
9 pages • 8.5 x 11 in • 522 KB
Delaware |
9 pages • 8.5 x 11 in • 439 KB
District of Columbia |
9 pages • 8.5 x 11 in • 522 KB
Florida |
9 pages • 8.5 x 11 in • 503 KB
Georgia |
9 pages • 8.5 x 11 in • 543 KB
Idaho |
9 pages • 8.5 x 11 in • 543 KB
Illinois |
9 pages • 8.5 x 11 in • 439 KB
Indiana |
9 pages • 8.5 x 11 in • 522 KB
Iowa |
9 pages • 8.5 x 11 in • 432 KB
Kansas |
9 pages • 8.5 x 11 in • 543 KB
Kentucky |
9 pages • 8.5 x 11 in • 439 KB
Maine |
9 pages • 8.5 x 11 in • 522 KB
Maryland |
9 pages • 8.5 x 11 in • 522 KB
Michigan |
9 pages • 8.5 x 11 in • 439 KB
Minnesota |
9 pages • 8.5 x 11 in • 432 KB
Mississippi |
9 pages • 8.5 x 11 in • 432 KB
Missouri |
9 pages • 8.5 x 11 in • 484 KB
Montana |
9 pages • 8.5 x 11 in • 299 KB
Nebraska |
9 pages • 8.5 x 11 in • 432 KB
Nevada |
9 pages • 8.5 x 11 in • 428 KB
New Hampshire |
9 pages • 8.5 x 11 in • 522 KB
New Jersey |
9 pages • 8.5 x 11 in • 439 KB
New York |
10 pages • 8.5 x 11 in • 263 KB
North Carolina |
9 pages • 8.5 x 11 in • 522 KB
Ohio |
9 pages • 8.5 x 11 in • 522 KB
Oklahoma |
9 pages • 8.5 x 11 in • 543 KB
Oregon |
9 pages • 8.5 x 11 in • 543 KB
Pennsylvania |
9 pages • 8.5 x 11 in • 439 KB
Rhode Island |
9 pages • 8.5 x 11 in • 522 KB
South Carolina |
9 pages • 8.5 x 11 in • 299 KB
South Dakota |
9 pages • 8.5 x 11 in • 432 KB
Tennessee |
9 pages • 8.5 x 11 in • 543 KB
Texas |
9 pages • 8.5 x 11 in • 430 KB
Utah |
9 pages • 8.5 x 11 in • 299 KB
Vermont |
9 pages • 8.5 x 11 in • 522 KB
Virginia |
9 pages • 8.5 x 11 in • 424 KB
Washington |
9 pages • 8.5 x 11 in • 543 KB
West Virginia |
9 pages • 8.5 x 11 in • 543 KB
Wisconsin - Claims-Made |
9 pages • 8.5 x 11 in • 432 KB
Wisconsin - Occurrence |
9 pages • 8.5 x 11 in • 409 KB
Wyoming |
9 pages • 8.5 x 11 in • 543 KB

Physician Corporations

Payment Plan Options |
1 page • 8.5 x 11 in • 116 KB
Universal Fraud Warning |
2 pages • 8.5 x 11 in • 61 KB
Alabama |
4 pages • 8.5 x 11 in • 197 KB
Alabama Arbitration Agreement |
1 page • 8.5 x 11 in • 160 KB
Arizona |
4 pages • 8.5 x 11 in • 220 KB
Arkansas |
4 pages • 8.5 x 11 in • 220 KB
Colorado |
4 pages • 8.5 x 11 in • 220 KB
Connecticut |
4 pages • 8.5 x 11 in • 146 KB
Delaware |
4 pages • 8.5 x 11 in • 172 KB
District of Columbia |
4 pages • 8.5 x 11 in • 146 KB
Florida |
4 pages • 8.5 x 11 in • 196 KB
Georgia |
2 pages • 8.5 x 11 in • 220 KB
Idaho |
4 pages • 8.5 x 11 in • 220 KB
Illinois |
4 pages • 8.5 x 11 in • 172 KB
Indiana |
4 pages • 8.5 x 11 in • 146 KB
Iowa |
4 pages • 8.5 x 11 in • 200 KB
Kansas |
4 pages • 8.5 x 11 in • 220 KB
Kentucky |
4 pages • 8.5 x 11 in • 172 KB
Maine |
4 pages • 8.5 x 11 in • 146 KB
Maryland |
4 pages • 8.5 x 11 in • 146 KB
Michigan |
4 pages • 8.5 x 11 in • 172 KB
Minnesota |
4 pages • 8.5 x 11 in • 200 KB
Mississippi |
4 pages • 8.5 x 11 in • 200 KB
Missouri |
4 pages • 8.5 x 11 in • 184 KB
Montana |
4 pages • 8.5 x 11 in • 154 KB
Nebraska |
4 pages • 8.5 x 11 in • 200 KB
Nevada |
4 pages • 8.5 x 11 in • 208 KB
New Hampshire |
4 pages • 8.5 x 11 in • 146 KB
New Jersey |
4 pages • 8.5 x 11 in • 172 KB
New York |
5 pages • 8.5 x 11 in • 207 KB
North Carolina |
4 pages • 8.5 x 11 in • 146 KB
Ohio |
4 pages • 8.5 x 11 in • 146 KB
Oklahoma |
4 pages • 8.5 x 11 in • 220 KB
Oregon |
4 pages • 8.5 x 11 in • 220 KB
Pennsylvania |
4 pages • 8.5 x 11 in • 172 KB
Rhode Island |
4 pages • 8.5 x 11 in • 146 KB
South Carolina |
4 pages • 8.5 x 11 in • 154 KB
South Dakota |
4 pages • 8.5 x 11 in • 200 KB
Tennessee |
4 pages • 8.5 x 11 in • 220 KB
Texas |
4 pages • 8.5 x 11 in • 180 KB
Utah |
4 pages • 8.5 x 11 in • 154 KB
Vermont |
4 pages • 8.5 x 11 in • 146 KB
Virginia |
4 pages • 8.5 x 11 in • 176 KB
Washington |
4 pages • 8.5 x 11 in • 220 KB
West Virginia |
4 pages • 8.5 x 11 in • 220 KB
Wisconsin |
4 pages • 8.5 x 11 in • 172 KB
Wyoming |
4 pages • 8.5 x 11 in • 220 KB

Physician Supplemental

Payment Plan Options |
1 page • 8.5 x 11 in • 116 KB
Practice Hours Supplemental Application |
1 page • 8.5 x 11 in • 159 KB
Telemedicine Questionnaire |
4 pages • 8.5 x 11 in • 295 KB

Paramedicals

Payment Plan Options |
1 page • 8.5 x 11 in • 116 KB
Universal Fraud Warning |
2 pages • 8.5 x 11 in • 61 KB
Alabama |
3 pages • 8.5 x 11 in • 190 KB
Alabama Arbitration Agreement |
1 page • 8.5 x 11 in • 160 KB
Arizona |
3 pages • 8.5 x 11 in • 216 KB
Arkansas |
3 pages • 8.5 x 11 in • 216 KB
Colorado |
3 pages • 8.5 x 11 in • 216 KB
Connecticut |
3 pages • 8.5 x 11 in • 221 KB
Delaware |
3 pages • 8.5 x 11 in • 167 KB
District of Columbia |
3 pages • 8.5 x 11 in • 221 KB
Florida |
3 pages • 8.5 x 11 in • 181 KB
Georgia |
3 pages • 8.5 x 11 in • 216 KB
Idaho |
3 pages • 8.5 x 11 in • 216 KB
Illinois |
3 pages • 8.5 x 11 in • 167 KB
Indiana |
3 pages • 8.5 x 11 in • 221 KB
Iowa |
3 pages • 8.5 x 11 in • 174 KB
Kansas |
3 pages • 8.5 x 11 in • 216 KB
Kentucky |
3 pages • 8.5 x 11 in • 167 KB
Maine |
3 pages • 8.5 x 11 in • 221 KB
Maryland |
3 pages • 8.5 x 11 in • 221 KB
Michigan |
3 pages • 8.5 x 11 in • 167 KB
Minnesota |
3 pages • 8.5 x 11 in • 180 KB
Mississippi |
3 pages • 8.5 x 11 in • 180 KB
Missouri |
3 pages • 8.5 x 11 in • 134 KB
Montana |
3 pages • 8.5 x 11 in • 137 KB
Nebraska |
3 pages • 8.5 x 11 in • 180 KB
Nevada |
3 pages • 8.5 x 11 in • 168 KB
New Hampshire |
3 pages • 8.5 x 11 in • 221 KB
New Jersey |
3 pages • 8.5 x 11 in • 167 KB
New York |
4 pages • 8.5 x 11 in • 156 KB
North Carolina |
3 pages • 8.5 x 11 in • 221 KB
Ohio |
3 pages • 8.5 x 11 in • 221 KB
Oklahoma |
3 pages • 8.5 x 11 in • 216 KB
Oregon |
3 pages • 8.5 x 11 in • 216 KB
Pennsylvania |
3 pages • 8.5 x 11 in • 167 KB
Rhode Island |
3 pages • 8.5 x 11 in • 221 KB
South Carolina |
3 pages • 8.5 x 11 in • 137 KB
South Dakota |
3 pages • 8.5 x 11 in • 180 KB
Tennessee |
3 pages • 8.5 x 11 in • 216 KB
Texas |
4 pages • 8.5 x 11 in • 170 KB
Utah |
3 pages • 8.5 x 11 in • 137 KB
Vermont |
3 pages • 8.5 x 11 in • 221 KB
Virginia |
3 pages • 8.5 x 11 in • 180 KB
Washington |
3 pages • 8.5 x 11 in • 216 KB
West Virginia |
3 pages • 8.5 x 11 in • 216 KB
Wisconsin |
3 pages • 8.5 x 11 in • 167 KB
Wyoming |
3 pages • 8.5 x 11 in • 216 KB

Allied Healthcare Professionals

Payment Plan Options |
1 page • 8.5 x 11 in • 116 KB
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

Payment Plan Options |
1 page • 8.5 x 11 in • 116 KB
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