Get Tx Tmlt Individual Application For Professional Liability Coverage 2016-2025

This guide provides clear, step-by-step instructions for completing the TX TMLT Individual Application for Professional Liability Coverage online. By following these steps, users will ensure the application is filled out correctly and submitted efficiently.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide general information. Fill in your first name, middle name, last name, date of birth, Texas medical license, and contact details including office phone and email addresses.
3. List all Texas office locations. Indicate the percentage of time you spend at each location.
4. Specify your preferred billing address and mailing address. You can choose from home, primary office, or another address.
5. Detail your hospitals of practice in Texas, including the type of privileges you hold at each.
6. Indicate if any part of your practice is outside of Texas, and provide details if applicable.
7. Answer questions regarding your previous insurance history. Include insurance company names, coverage dates, and limits of liability.
8. Select your requested coverage effective date, and check the desired type of professional liability coverage and limits.
9. Complete the professional practice information, including your medical school history and current practice operations.
10. Fill out the authorization statement at the end, sign, and date the application once all sections are completed.
11. Once finished, save your changes, and you can download, print, or share the form for submission.

Ensure your application is completed accurately and submit it online today.