State regulations and legal environments may limit the scope or availability of certain programs/resources. Please contact COPIC for details about your specific state.
Please select one of the following:
Allied Health Employee and Independent Contractor Application
Note: Additional supplemental applications may be required based on your specialty. Our staff will contact you about this information.
Allied health professionals who are required to submit an application for coverage:
Entity Professional Liability Application
One policy for coverage for a practice entity or partnership as well as physicians and allied health professionals.
Non-Acute Care Facility Application
Hospital Employed/Contracted Physician
Please use this application in addition to the previous two for each individual you would like to cover under your policy
