Medical Reimbursement Claim Form Template

Customize template

Use the drag and drop editor to remove, duplicate or add new fields in real time. Change the form design and upload a logo. Then configure autoresponder messages to give claimants peace of mind their request is up for review. Also, you can opt to show a thank you screen upon form completion.

Publish template

When you are satisfied with the content and structure of your medical reimbursement claim form, all you have to do is copy the code and embed it into a website. Or share the form URL to an email list or on web platforms of your choice. Since the form is mobile responsive, employees will be less discouraged to quit it mid-way.

Collect & manage data

Processing medical reimbursement claims is both easy and safe with our online forms. All the submissions live together in a secure database. It’s an intuitive interface that monitors everything at once to make sure all the reimbursement claims are reviewed. Or you can choose to download the data table and manage it from your desktop. Furthermore, we provide many integration options to sync your data. And, if you’re looking for securing your protected health information, we offer HIPAA-compliance for forms upon request, at a price.

Optimize processes

Simplify medical reimbursement claims for your employees with web forms that save a lot of time. To illustrate, you will receive real-time email notifications each time a medical reimbursement request comes in. So, create an account on 123FormBuilder today and start to digitize your workflows!