Trupanion Claim Form PDF Details

If you are the owner of a pet, then you know that there is always a chance that something could go wrong. When something does go wrong, it's important to have insurance to cover the costs. Trupanion is one of the best pet insurance providers available, and their claim form is simple to fill out. In this blog post, we'll provide an overview of the Trupanion claim form and how to fill it out. We'll also provide some tips for making the process as smooth as possible.

The table features information about the trupanion claim form. You will have the assumed time it would require you to complete the form and several extra details.

QuestionAnswer
Form NameTrupanion Claim Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namestrupanion claims, trupanion claim, trupanion login, trupanion file a claim

Form Preview Example

Claim Form

Fax: 1.866.405.4536

Phone: 1.800.569.7913

Part A :: To be completed by pet owner

IMPORTANT: We want to respond to your claim as quickly as possible so please fill out ALL information below as well as attaching:

1.Your pet’s medical records from all previous and current veterinary or emergency clinics 2 years prior to enrollment through present. (Unless you have provided the history previously, then just any new medical history.)

2.A copy of your veterinarian’s itemized invoice or an official pharmacy receipt.

Name:

Address:

Telephone:

Email:

Claim Total:

$

 

 

Pet's name:

 

 

 

Policy #:

 

 

 

 

 

 

 

 

 

Species:

 

 

 

Pet's Age:

 

 

Cat

Dog

 

 

 

 

 

 

 

 

 

 

Sex:

 

 

 

 

 

 

Male

Female

 

 

 

Spayed/Neutered:

Spayed/Neutered Date (mm/dd/yy):

 

 

 

 

 

Preferred Contact Times:

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

Has your pet been to any other vets prior to enrollment?

Yes

 

No

Please list all veterinary hospitals visited 2 years prior to enrollment through present.

I understand I am financially responsible to my veterinarian for the entire treatment. I understand that this claim may not be covered or may exceed my plan benefits. I authorize my veterinarian(s) to release my pet’s medical records to Trupanion. Claims must be submitted for processing within 90 days of treatment or service.

Your signature

Date (mm/dd/yy)

Part B :: To be completed by attending veterinarian

This pet required care due to an:

Illness Accident/Trauma

Date of injury OR when illness first appeared (mm/dd/yy):

Has this pet been seen by another vet clinic? If yes, which clinic?

Has the pet owner been following your recommended routine care program?

Yes

No

FOR VETERINARIAN USE ONLY

Process as Claims ExpressTM (direct payment to the veterinarian)* Type and cause of injury OR illness diagnosis:

Practice Stamp or Printed Name & Number of Clinic:

I confirm to the best of my knowledge the above statements are true in every aspect.

Signature of attending veterinarian

Print name

Date (mm/dd/yy)

Part C :: Claim submission

By toll free fax:

By mail:

1.866.405.4536

907 NW Ballard Way

 

Trupanion

 

Seattle, WA 98107

*Claims ExpressTM

A great way to better serve pet owners - have us pay you directly!

Call and ask about a pre-approval:

Claims ExpressTM fax only:

1.800.569.7913

1.866.729.2915

REV - 8.11 Trupanion plans are underwritten by American Pet Insurance Company.

Watch Trupanion Claim Form Video Instruction

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