Your Business Name

REQUEST FOR REIMBURSEMENT:

A cheque will be sent to you at the address provided below once we confirm your health coverage. 

Please be sure to submit your detailed mailing information including Street Address, Unit Number, City/Province, and Postal Code.
Please let us know if you have any additional questions, comments, or concerns.
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Thank you! Your message was sent successfully. A member of our team will be in touch with you shortly.

Can't find what you're looking for?  Email  [email protected]  for help. 

/
Lightbox image