If you are an individual physician and would like to apply for membership, please complete the following:

Individual Application for NJHPIX Membership and Insurance;

Office Practice Risk Questionnaire

Subscribers Agreement (Original and Copy). The original must be returned to NJHPIX. The copy is for the member’s records.

Claim/Suit/Incident Supplement

If your desired retroactive date precedes the desired effective date, please complete the Prior Acts Application

Surplus Contribution Agreement. Make your check payable to NJHPIX, or if you would like to finance the surplus contribution click here Surplus Contribution and Premium Financing Information and Application

If someone other than the insured is paying the premium please complete Assignment of Unearned Premium

If you have a corporation or partnership that you would also like to insure, complete the following:

Entity Liability Application for NJHPIX Membership and Insurance

Subscribers Agreement (Original and Copy). The original must be returned to NJHPIX. The copy is for the member’s records.

Claim/Suit/Incident Supplement

If your desired retroactive date precedes the desired effective date, click here, complete the Prior Acts Application and return to NJHPIX.