How to Apply

Getting coverage in place isn't difficult or complicated.

Please have the following information available to complete your application.

• Licensure Information – A copy of each active state license and certification you hold.
• Previous Insurance Information – A copy of your current Declarations Page (if you are currently insured).

Apply Online Today

• Connecticut, Florida and Nevada
• All Other States

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For Agents and Brokers

1. Click below to select the correct application:

   Applications for Connecticut, Florida and Nevada

   PSIC RPG:

   • Professional Liability Application
   • Professional Liability Entity Application
   • Professional Liability New Graduate Application
   • Professional Liability Renewal Questionnaire
   • Locum Tenens Application
   • Dental Anesthesia Supplement
   • Mobile Dentistry Supplement
   • Dental Claim Information Form
   • Request for Dental Policy Limit Change
   • Request to Add the Employee Endorsement

   Applications for All Other States

   PSIC:
   • Professional Liability Application
   • Professional Liability Entity Application
   • Professional Liability New Graduate Application
   • Professional Liability Renewal Questionnaire
   • Locum Tenens Application
   • Anesthesia Supplement
   • Mobile Dentistry Supplement
   • Policy Limit Change Request
   • Claim Information Form
2. Complete, print and sign the application.
3. Send it to PSIC Dental:
   • Please follow the submission instructions found on the PSIC Dental application.