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Pet Insurance & Billing Confirmation Form

A billing confirmation template — insurer, policy and preferred payment method captured, so costs and claims are clear before treatment.

Description

Clear billing is kinder on everyone, and this form sets it up before treatment rather than at the till. It confirms whether a pet is insured, the policy details, and how the owner would like to settle the practice’s fees — so there are no awkward surprises when the bill arrives. It captures what the practice needs to handle billing smoothly: insurer and policy number, whether the owner wants the practice to claim directly (paying only the excess, where offered), understanding that the excess and any shortfall remain the owner’s responsibility, and the preferred way to settle fees. It deliberately asks only for details the practice needs — not card or bank numbers, which are always taken securely in person or through a proper payment system. Use it at registration or before planned treatment. Free, brandable, and it makes the money side clear and calm, which clients genuinely appreciate.

Form fields

Everything the Pet Insurance & Billing Confirmation Form above collects — 11 fields, so you can see exactly what it captures before you make it your own.

Insurance & Billing Confirmation

  • Pet's name

    Short Answer Icon
    Short Answer

  • Is your pet insured?

    Yes/No Icon
    Yes/No

  • Insurer (if insured)

    Short Answer Icon
    Short Answer

  • Policy number (if insured)

    Short Answer Icon
    Short Answer

  • Would you like us to claim directly from your insurer, where we offer it?

    Yes/No Icon
    Yes/No

  • Please acknowledge

    Multi-Select Icon
    Multi-Select

  • Preferred way to settle fees

    Single-Select Icon
    Single-Select

  • Your name

    Name Icon
    Name

  • Contact number

    Telephone Icon
    Telephone

  • Email address

    Email Icon
    Email

  • Billing confirmation

    Consent Icon
    Consent
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Template FAQs

Common questions about the Pet Insurance & Billing Confirmation Form — what it captures, when to use it, and how to make it your own.

What does the billing confirmation capture?

Whether your pet is insured, your insurer and policy number, whether you’d like the practice to claim directly where offered, and your preferred way to settle fees. It makes costs and claims clear before treatment.

Will this form ask for my card or bank details?

No — it only captures your insurer, policy and payment preference. Card and bank details are always taken securely in person or through the practice’s proper payment system, never on a general form like this.

What is direct insurance claiming?

Some practices will claim from your insurer directly, so you pay only the excess rather than the full bill up front. The form asks whether you’d like this, where the practice offers it.

Am I still responsible for the excess?

Yes — your policy excess and any amount your insurance doesn’t cover remain your responsibility. Confirming this up front means the final bill holds no surprises.

What if my pet isn't insured?

That’s fine — the form simply records that, and confirms how you’d prefer to settle fees, so the practice can keep you informed about costs as treatment progresses.

Is the confirmation form free?

Yes — free with a Fun Forms account, fully customisable, and ready to embed or share as a link.

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