Notice to policyholders in the Southeast recently affected by Hurricane Helene and/or Hurricane Milton.

Please note, our Payment Portal for malpractice premiums will be down for scheduled maintenance the evening of December 6 through December 7, 2024.

Professional Solutions Menu

Personalized Risk Assessment Form

All fields marked with * are required.

Contact Information

Practice/Clinic Name *

Contact Name *

Address *

Address Line 2

City *

State *

ZIP *

Office Phone *

Office Email *

Website

Policy Number

Agency Information

If you are currently working with an agent, please provide the following information.

Agency Name

Agent Name

Agent Email

Agent Phone

Additional Information