Download an application as an Adobe PDF file that you can complete and return.

Please refer to our Completion and Delivery Instructions prior to opening any of the applications on this page.


There are 3 easy ways to apply for MLMIC dental professional liability coverage.

  1. Online
    Start or complete an application at the MLMIC Insurance Company rapid application portal.
    Apply Online
  2. Mail (or Email/Fax)
  3. Phone
    Need help? Give us a call at 800-ASK-MLMIC (800-275-6564).

Hospitals and Groups:

Contact a MLMIC representative today.