Montana Medical Legal Panel Exemption Survey

The Montana Medical Legal Panel (MMLP/Panel) is funded through an annual assessment levied on all health care providers covered by the Montana Medical Legal Panel Act. The assessment is set each year and apportioned among physicians, dentists, podiatrists, hospitals, and other licensed health care facilities. Under certain conditions, the Panel may exempt a health care provider from this assessment.

Please complete this brief survey to determine if you qualify for an exemption.

Question Title

* 1. Please complete your contact information.