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ASK A
VET™
Insurance Claim Examination Certificate
A free fillable veterinary attestation of findings, treatment and fees to support a pet insurance claim. Sign on screen, then print or download as a PDF. Nothing you enter is stored or sent anywhere.
Clinic Details
Policyholder Details
Patient's Details
Clinical Details
Fees
Veterinary Certification
I, the undersigned veterinary practitioner, certify that the information recorded on this certificate is true and accurate, based on my examination of the animal and the clinical records held by this practice. In my opinion the treatment described was reasonably necessary for the condition recorded. The clinical records relating to this claim are available to the insurer on request, with the policyholder's consent.
Veterinarian signature
Clinic stamp
(stamp the printed copy)
Built by Dr Duncan Houston for ASK A VET™ · askavet.com
Free veterinary forms, clinical calculators and pet health tools. Talk. Track. Trust.
Free veterinary forms, clinical calculators and pet health tools. Talk. Track. Trust.
Nothing typed into this form is sent to or stored by askavet.com. All data stays in your browser and leaves only in the PDF or printout you create. Insurers usually have their own claim forms; this certificate supplements them where a signed veterinary attestation is requested. Complete it from the clinical records, not from memory.