Applications and Forms for Mississippi Physicians Only

Applications for Mississippi Physicians:

Please browse the following list of applications to determine which one best meets your needs. All applications must be completed in their entirety.

Any application questions may be directed Donna Parker at (800) 686-2734.

Please submit all applications to underwriting via fax (512) 275-1240 or by mail:

Advocate, MD Insurance of the Southwest Inc.
811 Barton Springs Road
Suite 800
Austin, TX 78704

Claim Release Authorization for Mississippi Physicians

The claim release authorization is required when requesting claim history and/or loss runs for certification. MMAP Claim Release Authorization