Coverage Applications-Colorado

Below are medical professional liability insurance applications by coverage type. Please complete the applications listed in the appropriate section and then submit them to COPIC:

  • Email: sales@copic.com
  • Fax: 877.263.6665
  • Mail: Attn: COPIC Sales Department, 7351 E. Lowry Blvd., Ste. 400, Denver, CO 80230

Colorado—Individual Physicians or Allied Health Professionals

1) Colorado Health Care Professional Credentials Application (CHCPCA)—both physicians and allied health professionals need to complete this.

2) In addition, please select one of the following:

PLEASE NOTE: Additional supplemental applications may be required based on your specialty. Our staff will contact you about this information. To see a list of the allied health professionals that require an application, please click on the "read more" button.

Allied health professionals who are required to submit an application for coverage:

  • Acupuncturist
  • Advanced Practice Nurse
  • Aesthetician
  • Child Health Associate
  • Clinical Nurse-Specialist
  • CRNA/Nurse Anesthetist
  • Cytotechnologist
  • Electrologist
  • Embryologist
  • Emergency Medical Technician
  • Endermologist
  • Laser Technician
  • Microdermabrasionist
  • Nurse Clinician
  • Nurse Midwife
  • Nurse Practitioner
  • Optometrist
  • Orthopaedic Physician Assistant
  • Perfusionist
  • Pharmacist
  • Physician Assistant
  • Physicist
  • Physiologist
  • Psychologist
  • Psychotherapist
  • Radiology Practitioner Assistant
  • Surgical Assistant
  • Surgical Technician

Colorado—Medical Group Practices

1) Please select one of the following:

2) In addition to the above applications, please refer to the requirements in the Colorado Individual Physicians or Allied Health Professionals section above for each physician/allied health professional that will be included in your coverage.

Colorado—Hospital or Medical Facility

1) Please select one of the following:

2) In addition, please use the following applications for each individual you would like to cover under your policy:

Contact Us

Contact our staff with questions or to get started. Looking for an agent? We can help with that too.
COPIC Sales
800.421.1834, ext. 6186 or 720.858.6186
 
 

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