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Treatment Expense Reimbursement Form

Veterans' Affairs client number (if known)

First name

Family name

Date of birth

Email address

You can claim for multiple expenses by selecting 'Add another expense'.

Details of the expense

Which injury or illness listed on your treatment card is the expense related to?

Date of visit

Amount charged

If you have another expense, click 'Add another expense'

Upload all receipts related to your treatment

Make sure you press 'Upload x files' before continuing to the next page.

If you use a mobile device, you can take photos of paper receipts by selecting 'Browse files' and then 'Take photo'.

the expenses I have claimed are in relation to my accepted injury or illness
the information I have given in this claim form is true and correct
Veterans' Affairs may obtain further information to assess and decide on my claim
Veterans' Affairs will use my personal information in accordance with the Privacy Statement available on this website
I authorize the collection and disclosure of health, clinical, or other personal information by or to Veterans' Affairs or by or to named agencies held by any doctor or health practitioner or named agencies, or service providers (such as ACC), or contractors for the purposes set out in the privacy statement; for the purposes of assessment of this claim; administration of any resulting entitlement; and the provision of any services, treatment or rehabilitation under the Veterans' Support Act 2014
I have read any obligations stated within this form.

Yes, I acknowledge the above, and I authorise the use, collection, and disclosure of my personal information as set out above.

Verification of your identity and consent

Was this form completed by the person making the claim or a person with the authority to act on behalf of the claimant?

Last Modified: 16 September 2025