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Complete the member reimbursement form and a member of our team will be in touch.
First Name*
Last Name*
Email*
Curative Member ID*
Plan Type*
Select plan type
Date of Service*
Did you pay for the service rendered?*
Choose an option
Did you complete your baseline visit?*
Choose an option
Have you already sent in a request for these services?*
Choose an option
Is this a claim for services performed outside of the United States?*
Choose an option
Upload completed reimbursement form (PDF only)
*
Upload two forms of proof of payment (e.g., paid receipt, super bill, transaction statement — PDF only)
*
Submit
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