Applications and Forms
Below is a listing of our most frequently used applications and supplemental forms. To access a document, click on the link, save the document to your computer, complete the form and return to CARE or the submitting agent via email at teresa@care-ins.com or fax at 502-895-6406.
Physician Applications and Forms
- CARE – Application for Physicians and Surgeons
- Renewal Application
- Dental Application
- Dental Renewal Application
- Chiropractor Application
- Professional Liability Claims Information
- Pain Management Supplement
- Part-Time Application
- Prior Acts Statement
- Warranty of No Known Claims
- BHRT Sample Consent Form
- Chiropractor Supplemental Claims Form
- Coverage Acceptance Form
- Dental Ancillaries Application
- Dental Ancillaries Renewal Application
- HCG Sample Consent Form
- Medical Directorship Supplement
- OPV Audit
Supplemental Forms
- Anesthesiology Supplement
- Applicant’s Authorization and Certification
- Bariatric Surgery Supplement
- Dermatology, Cosmetic Surgery, Plastic Surgery, Aesthetic Surgery Supplemental Application
- Emergency Medicine Supplement
- General Surgery Supplement
- OB/GYN Supplement
- Urology Supplement
- Telemedicine Supplemental Questionnaire
- Urgent Care Supplement
Non-Physician Healthcare Providers Applications
- Chiropractor Professional Liability Application
- Non-physician Application
- Non-physician Renewal Application
