Information Request

Are you interested in more information about The Psychiatrists' Program? Please complete the form below and we will send you the requested information along with complimentary risk management tips designed with the psychiatrist in mind.


Thank you for your interest in The Psychiatrists' Program!

Please provide the following contact information:

First name

Middle initial

Last name

Suffix

Organization

Daytime Phone

Email
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Practice state

Address 1

Address 2

City

State

Zip Code
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Are you a member of a group practice?

Group name

Group contact

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Please call (800) 245-3333 or e-mail TheProgram@prms.com for more information about The Program.

Apply Today!

Apply Today
Thank you for your interest in The Psychiatrists' Program! How can we serve you?

For more information about individual coverage, please call (800) 245-3333 or e-mail TheProgram@prms.com.