Professional Liability — Applications

For each of the following applications, forms, and questionnaires, please complete the information, sign, and send it to us. Send by fax to (206) 343-7100, by e-mail to marketing@phyins.com, or by mail to Physicians Insurance, 1730 Minor Avenue, Suite 1800, Seattle, WA 98101. Please note that we require a signature for processing. For personal assistance, please contact our Marketing Department at (206) 343-7300 or 1-800-962-1399.

Physicians and Surgeons Professional Liability Insurance Application 
 

Applications and Forms
For personal assistance with any of the following applications and forms, please contact our Underwriting Department at (206) 343-7300 or 1-800-962-1399.

Ambulatory Surgical Facilities Underwriting Information Form
Corporation/Partnership Professional Liability Insurance Application (available for practices with two or more physicians)
Increase Limits of Liability Application
Locum Tenens Application
Midlevel Provider Application
Midlevel Providers Providing Care to Obstetrical Patients Application
Moonlighting Residents & Fellows Application
Per-Diem Physician Application
Practice Change Application
Suspension Request Form

Supplemental Questionnaires
For personal assistance with any of the following specialty questionnaires, please contact our Underwriting Department at (206) 343-7300 or 1-800-962-1399.

Acupuncture Questionnaire
Bariatric Surgery Questionnaire
Body Imaging Questionnaire
Nighthawk Questionnaire
Pain Management Questionnaire
Practice Association Questionnaire
Refractive Surgery Questionnaire
Sleep Medicine Questionnaire
Teleradiology Questionnaire

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