Use the form below if your are a Medical Provider who wishes to participate in Companion Property & Casualty Insurance Group's Medical Provider Network.

Provider Network Participation Request

Please fill out the form completely. When you have finshed filling it out, save the form on your computer and then send it to us by attaching the form to an e-mail. Forms can be e-mailed to network.management@companiongroup.com .

Alternatively, you may also fax the completed form to 803-264-5149.

Please allow three to five working days for one of our Medical Network administrators to contact you.