Trupanion Claim Form
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1Claim Form
Fax: 866.405.4536 • Phone: 855.266.2151
PREFERRED
Name on policy:
Day phone:
Your pet’s name:
Evening phone:
Your policy number (if known):
Email:
Filed a claim for this condition before?
Yes - We like to keep things simple. Only complete this section.
Reason for treatment:
Related claim number (if known):
No - Complete sections A and B
A: Your pet’s info
- Completed by pet owner. If you have provided this information before, and nothing has changed, skip to Section B.
Please, list all veterinary hospitals your pet has visited:
Date of Birth:
Adoption:
(M/Y)
(M/Y)
City:
Spay/Neuter:
Yes
No Date:
(M/Y)
Completed at:
City:
*Tip: In order to process your claim, we will need medical records
City:
on file from all hospitals where your pet has been seen, including
vaccine, routine, and emergency visits.
Your signature will authorize your hospital to provide us a copy of your pet’s medical records.
Signature:
B: Treatment info
- Completed by your veterinarian
Reason for treatment:
Date of first signs:
Due to an accident?
Yes
No
Reason for treatment:
Date of first signs:
Due to an accident?
Yes
No
Dental Claims Only: Pet received a dental exam in the last
Date of pet’s first visit at your hospital:
12 months & owner has followed dental recommendations.
Yes
No
Hospital Preferred Contact:
Day phone:
Attending veterinarian:
Evening phone:
Veterinary hospital name:
Email:
Process this claim as Claim Express? (For veterinarian use only.)
Submit Claims Express claims only to:
Email: or
Yes - Please pay the veterinary practice directly
Fax: 866.729.2915
No - Please reimburse the pet owner
We love our pets and our customers! – Yet, for your protection, state 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 state prison.
Mailing Address:
US: 907 NW Ballard Way
Canada: PO Box 34538 1268 Marine Drive
Seattle, WA 98107
North Vancouver, BC V7P 1T2
Underwritten by American Pet Insurance Company (USA) and Omega General Insurance Company (Canada).
CF012-1213
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