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We encourage our California insured physicians to use binding arbitration to resolve physician-patient disputes. If you would like to order additional Binding Arbitration Agreements, please complete and return the order form below.

If you have questions regarding binding arbitration, please call (800) 421-2368, extension 1243.

You can also read an overview on physician-patient arbitration, “Resolving Disputes Through Binding Arbitration,” or view a sample of the agreement form (PDF 42K, one page).

Policy Number:	All fields are required
Policy Name/Group:
Address:
City:
State:	CA (for California members)
Zip Code:
Language / Quantity	English    100 200 300 400 500 600 700 800 900 1000    Spanish   100 200 300 400 500 600 700 800 900 1000
Have you received training from the Patient Safety Department on the use of the forms?
	Yes      No
Contact Info (if we have questions about your order):
E-mail:
Daytime Telephone:

In addition to ordering online, you can also fax this completed form to (707) 226-0162 or mail it to:

The Doctors Company Arbitration Program,
185 Greenwood Road, Napa, CA 94558.

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