Insurance Claim Request | The Ealing Vet

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Insurance Claim Request Form

If you require us to complete an insurance claim for your pet's treatment with us, please complete the below form.

Please note that for new claims/conditions, an administration fee of £25 must be paid before we can complete the claim for you. We will send you a payment link on receipt of your request.

For certain insurance companies, such as Pet Plan and Every Paw, you must 'action' your claim on their website first, before submitting your request.

Please check the claim requirements with your insurance companies; many will all be completed online now, however there are some companies that still require paper forms. If your insurance company requires a paper form, please complete and sign your section before uploading it in the form below.

Our 'How To' Guide for Insurance Claims

I agree that I have checked whether I need to action my claim via my insurance company's website, or provide a signed paper claim form, before submitting my request

I agree that I have checked with my pet insurance company that my policy overs the condition and treatments for which I am claiming for

I understand that there is a £25 processing fee for new claims and that this must be payable before my insurance form is completed. Please note that this fee is not claimable against your insurance policy and is non refundable.

First name*

Last name*

Email*

Phone*

Address*

Including postcode

Patient Name*

Species*

Breed*

Age or DOB*

Sex*

Male

Female

Neutered/Entire*

Neutered

Entire

Insurance company*

For certain insurance comanies, such as Pet Plan and Every Paw, you will need to 'action' your claim via their website, as well as completing this form for us. Please ensure you have checked this before proceeding.

Brief description of illness/injury*

If a diagnosis is not know, please write the reason for your pet's appointment with us e.g. "drinking more" or "vomiting"

It this a new claim/condition?*

Yes

No - continuation claim

If your pet has received treatment for the same condition previously, and you have claimed for it on your policy, whether through us or another clinic, this is classed as a continuation claim. Please note that if this is a claim for a new condition/first claim, an administration fee of £25 must be paid before we are able to complete this for you. We will send you payment information on receipt of your request.

Treatment start date*

Treatment end date (if applicable)*

If the treatment is ongoing, please write 'n/a'

Policy number*

If you have a paper claim form, please upload here:

Who is the claim to be paid to?*

Policyholder

Vet (direct claim)

Please note that direct claims can only be submitted with prior agreement from The Ealing Vet. If we have not already agreed to this, your request for a direct claim may be rejected.

I agree that by submitting this form, I give The Ealing Vet permission to complete my pet's insurance claim on my behalf

Signature*

Sign in the box or use the keyboard to type.

Signature field is empty.

The Ealing Vet Limited
07545 326 792 (for urgent appointments only)
Company registration number: 16030888

Opening Hours:
Monday - Friday 07:30 - 17:00
Closed on bank holidays

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