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Home > Certified Nurse-Midwife Medical Malpractice Insurance Proposal Questionnaire

The only nationwide midwives malpractice insurance program with over a decade of continuous service to the midwifery community.

Many companies have provided Midwife Medical Malpractice coverage for a few years, abandoning the market when claims started coming in. Some coverage is offerred through companies with no or low financial ratings.
Our policies are offered through "A" rated companies.
Why take a chance with inexperienced or unrated companies? Our program's experience and long term committment to this market provide confidence that coverage will be there when you need it.
Our program insures Certified Nurse Midwives, Certified Professional Midwives, and Licensed Midwives.
Home birth coverage is available.

Get A Free Midwife Malpractice Insurance Quote - Put Our Staff Of Professionals To Work For You

Complete the form below for quick free quotes on Medical Malpractice Insurance policies. Don't wait. Your assets should be protected only by highly rated insurance companies that have demonstrated a long term commitment to midwives.

Midwife Medical Malpractice Insurance Proposal Questionnaire

Please answer all questions completely to assure that we can deliver a reliable premium indication. Our goal is to mail a malpractice insurance proposal within 10 days. View our privacy policy.

The questionnaire below is for proposals. To skip that step and apply for coverage now, click on the appropriate button below.

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Questionnaire

Contact Information

First Name:

Last Name:

Title:

Address:

City:

State:

Zip Code:

Email:

Medical Malpractice Insurance Information

Specialty:

Please send additional information concerning medical malpractice insurance for the specialty of

Contact:

Please contact the following person to set up an appointment or discuss this program:

Name:

Title:

Phone:

Insurer:

My current malpractice insurer is:

Current Premium:

Start Date:
The date I first entered practice is:

Student:

Are you currently a student?

No
Yes

My anticipated graduation date is:

Claims:

Have you ever had a Malpractice Claim against you (include cases decided in your favor)?

I have been claims free for years.

Yes

closed with a payment

closed without a payment

are pending

If no cases pending, date last case was closed:

Do you perform home births?

Also, please send information concerning:

Office, General Liability and Property Coverages

Worker Compensation Coverage

Submit

Please review the information entered in the form. If the above information is correct, press the "Submit" button below to complete your form submission.