Apply for Dental Malpractice Insurance

To assist in completing your application, please have the following information available.

• Licensure Information – A copy of each active state license and certification you hold.
• Previous Insurance Information – A copy of your current Declarations Page (if you are currently insured).

I practice in:

• Connecticut, Florida or Nevada
• All Other States

Agents & Brokers

Please follow the submission instructions found on the application.

Connecticut, Florida and Nevada Applications

• CT, FL & NV Professional Liability & Locum Tenens
  • Application
  • Entity Application
  • New Graduate Application
  • Renewal Questionnaire
  • Locum Tenens Application
• CT, FL & NV Application Supplements
  • Dental Anesthesia Supplement
  • Mobile Dentistry Supplement
• CT, FL & NV Policy Change Forms
  • Request for Dental Policy Limit Change
  • Request to Add the Employee Endorsement

All Other States Applications

• Professional Liability & Locum Tenens
  • Application
  • Entity Application
  • New Graduate Application
  • Renewal Questionnaire
  • Locum Tenens Application
• Application Supplements & Policy Change Forms
  • Anesthesia Supplement
  • Mobile Dentistry Supplement
  • Policy Limit Change Request