Insurance Application
Our new Insurance application is now available. Fill out the relevant sections and include it with the documents requested below.
EMS Medical Director Application (pdf)
EMS Medical Director Application (word)
EMS Medical Director Renewal Application (pdf)
EMS Medical Director Renewal Application (word)
EMS Medical Director Group Practice Application (pdf)
EMS Medical Director Group Practice Application (word)
EMS Group Practice Physician Supplement (pdf)
EMS Group Practice Physician Supplement (word)
EMS Locum Tenens Application (pdf)
EMS Locum Tenens Application (word)
Include a copy of your CV, a copy of the contracts for each service for which you wish coverage, and a certificate of insurance showing you have "Med Mal" for your primary occupation. (This policy will cover your EMS medical direction contracts only.)
Mail the completed packet with original signatures to:
Lapre Scali & Company Insurance Services, LLC
c/o Thomas James
6200 Coors Blvd., NW, Suite K-3
Albuquerque, NM 87120
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