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It’s easy to learn how much you might save by obtaining your professional liability coverage through Medical Professional Liability Agency, Ltd. (MPLA). Simply complete and submit the form below to receive a free, no-obligation quote.

California doctors click here

Contact Nancy Caro
1-800-822-8260 x5672
ncaro@medmalagent.com
Fax: 1-800-763-3776

Questions or Comments?
First Name:
Last Name:
Specialty:
Street Address:
City:
 State: Zip:
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Phone:
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Fax:
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E-mail Address:
Best Way To Contact You:
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Best Time To Call:
Refer-A-Friend:
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Address:
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Phone:
Current Coverage :

Claims Made (retro date: ) OR
Occurrence
Limits $ /$
Number of Locations:
Current Carrier:
Expiration Date:
Other Doctors In Practice:

Desired Coverage :

Claims Made (retro date: ) OR
Occurrence
Limits $ /$
Number of Locations:
Effective Date:

How many years have you been practicing?
In Current State: Years.  In Other States: Years
Have you had any claims in the last 10 years?: Yes No
If Yes, how many are still open?:    How many are closed?:
Have you taken a risk management course in the last 3 years?:
Yes No, but I'm interested in taking one
Are you a member of any association?: Yes No
If Yes, please list:

Questions or Comments:

Customer Service & Questions
Ari Mir 1-800-822-8260 x5548, fax: 1-800-763-3776
Medical Professional Liability Agency, Ltd.
P.O. Box 859 Rock Hill, NY 12775

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