Applications for Medical Professional Liability Insurance

Apply for medical professional liability insurance coverage or renew a current policy with Conventus.  To receive a quote, please submit all completed applications and documents to or contact your Conventus membership specialist.

Click the links below to download the applications.
New Member Applications
Physicians and Surgeons Professional Liability Insurance Application >
Corporate Entity Application >
Non-Physician Healthcare Provider Professional Liability Insurance Application >
Renewal Applications
Physician Renewal Application >
Corporate Entity Renewal Application >
Supplemental Applications
Locum Tenens Application >
Cosmetic Procedures Supplemental Application >
Gastroenterology Procedures Supplemental Application >
Ophthalmology Supplemental Application >
Pain Management Supplemental Application >
Physician Practice Location and Hours Update >
Bariatric Supplemental Application Questions >
Power of Attorney
Business Entity Policy Power of Attorney >
Individual Policy Power of Attorney >
Loss History / Credentialing
Loss History / Credentialing Release Form >
Questions? Contact us online or call (877) 444-0484 for information.