Credentialing Request Tell us your role Agent Underwriter Underwriter name Underwriter email address Agency name Agent name Agent email address Member/group name Policy number Documents requested Claims history report Loss run Detailed loss run (please include parameters) Please note that this form is only intended for the current Broker of Record on an Inforce policy. If you are seeking a credentialing report for a policy where you are not the Broker of Record, or the policy/member is no longer inforce, please complete the TDC Consent to Release form and email to memberservices@thedoctors.com. For questions, please visit thedoctors.com/credentialing. Please note that this form is only intended for the current Broker of Record on an Inforce policy. If you are seeking a credentialing report for a policy where you are not the Broker of Record, or the policy/member is no longer inforce, please complete the TDC Consent to Release form and email to memberservices@thedoctors.com. For questions, please visit thedoctors.com/credentialing. SUBMIT
