Reason for treatment - If unsure, please contact your hospital for more information
Hospital name: Treating veterinarian:
Illness/injury:
Have you filed a claim for this condition previously?
If yes, claim number: If no, date of first signs:
Illness/injury 2 (if applicable):
Have you filed a claim for this condition previously?
If yes, claim number: If no, date of first signs:
Policyholder name: Preferred phone:
Your pet’s name (please complete one form per pet):
Your policy number (if known):
For your protection, insurance laws require the following to appear on this form: Any person who knowingly presents a false or
fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in prison.
Trupanion is a registered trademark owned by Trupanion, Inc.
Underwritten in Canada by Omega General Insurance Company and in the United States by American Pet Insurance Company,
6100-4th Ave S, Seattle, WA 98108. Please visit AmericanPetInsurance.com to review all available pet health insurance products.
Questions? Claims@Trupanion.com • Phone: 855.266.2151
CLAIM FORM
Submit this completed form and hospital invoice by one of the following methods:
Claims paid to you: Claims paid to Veterinarian:
Claims@Trupanion.com 866.405.4536 VetDirectPay@Trupanion.com 866.729.2915
In order to avoid delays, all claims submitted must include a fully completed claim form and
accompanying itemized invoice(s) with all treatment descriptions and charge amounts clearly visible.
Your pet’s info - Complete only if you have not done so previously or if the information has changed
Date of birth: Date of adoption: Spay/Neuter: No Yes Date:
Is/was your pet insured under any other insurance provider? Yes No
If yes, provider name: Cancel date: OR Policy still active
Please, list all hospitals your pet has visited:
Name: City:
Name: City:
Submission of this claim form authorizes all veterinarians that your pet has received treatment from to provide us with
a copy of your pet’s medical records and confirms all information provided is true and accurate to the best of your
knowledge and belief.
I have paid my bill in full.
Reimburse by my selected payment method.
Call 855.266.2151 to set up direct deposit.
I have not yet paid my bill.
Reimburse by the hospital’s selected payment method.
Ask your vet if they will accept direct pay from Trupanion.
They can contact us to set this up.
Please note: Leaving this section unmarked will result in payment to you, the policyholder.
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