Applications

For your convenience we have provided links to all of the documents relevant to the application process. Please be sure to sign and date the signature lines on page 8 of the main application, the Retroactive Coverage Form, and all Supplemental Claim Forms. You should then print and fax the completed documents to us at 702-947-4488.

MedChoice Individual Professional Liability Application

MedChoice Corporation Professional Liability Application

MedChoice Midlevel Professional Liability Application