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Lone Star Alliance

Request Individual Quote

Please select the practice location fields.

* — Required fields

Practice Location State

Participation in your state's Patient Compensation Fund (PCF) may be required

LSA provides coverage outside of Texas. If you're requesting coverage for Texas only click here for the TMLT individual quote form.

Practice county

Do you currently work with one of these LSA contracted agencies?

Broker's Name

If you do not currently work with one of our contracted agencies we require your permission to connect you with one licensed in your state(s) to facilitate your quote. If you do not indicate your permission you cannot continue with this quote request.

Permission Granted

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