Online Application

Paper Application

Online Application

Complete the online application, and upon completion, the application will return you to a page where you can upload any supplementary documents needed.

Paper Application

Click the PDF application which will open on your computer, where you can complete it. Print it, Sign it and choose:

Email it:

Send it via email to Apply@MedMalDirect.com

Fax it:

Fax your forms to (844) 877-5939

Mail it:

Mail forms to
MedMal Direct Insurance Company
245 Riverside Ave, Suite 550
Jacksonville, FL 32202

 

If you have supplementary documents to get us, then simply UPLOAD YOUR FILES ONLINE to submit your documents directly to MedMal Direct. You may also submit the documents via E-mail, Fax or U.S. Mail as well.