VPI Pet Insurance Forms

Refer-A-Friend Form

• Refer-A-Friend Form (32KB)

Claim Forms

To download a claim form, please select your state of residence from the table below.

West	Southwest	Midwest	Southeast	Northeast
Alaska	Arizona	Illinois	Alabama	Connecticut
California	New Mexico	Indiana	Arkansas	D.C.
Colorado	Oklahoma	Iowa	Florida	Delaware
Hawaii	Texas	Kansas	Georgia	Maine
Idaho		Michigan	Kentucky	Maryland
Montana		Minnesota	Louisiana	Massachusetts
Nevada		Missouri	Mississippi	New Hampshire
Oregon		Nebraska	Tennessee	New Jersey
Utah		North Dakota	North Carolina	New York
Washington		Ohio	South Carolina	Pennsylvania
Wyoming		South Dakota	Virginia	Rhode Island
		Wisconsin	West Virginia	Vermont

Review Form

This form may be used as a cover sheet for your request to review a completed claim or an excluded condition.

• Review Form (74KB)

Medical Benefit Schedules

• Superior Plan Benefit Schedule (104KB)
• Standard Plan Benefit Schedule (100KB)
• Avian and Exotic Plan Benefit Schedule (97KB)

CareGuard^SM Benefit Schedules

(Formerly Pet Well Care Protection)

• CareGuard Core Coverage (24KB) (Formerly Pet Well Care Protection Core)
• CareGuard Premier Coverage (24KB) (Formerly Pet Well Care Protection Premier)
• Vaccination & Routine Care Coverage (26KB)

Policy Transfer Form

This form may be used to request your pet’s policy be transferred to a new owner.

• Policy Transfer Form (264KB)

Hospital Forms

• Physical Examination Record Form (165KB)
• Hospital Sign-In Sheet (14KB)