Online claiming provider agreement form (HW027)

Use this form to register for online claiming with us and the Department of Veterans' Affairs.

Download and complete the Online claiming provider agreement form.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 20 February 2020