Claims Forms

Our Health Spending Account claims forms are available below in PDF format. These are editable forms that can be filled out and e-mailed to us, or printed out and faxed/mailed to us.

Note: All claims forms submitted via e-mail require a signature, forms can be submitted to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

• Dental Claim - English
• Dental Claim - French
• Vision Claim - English
• Vision Claim - French
• Extended Health Claim - English
• Extended Health Claim - French

• Application Form
• Merchant Agreement
• Electronic Funds Transfer
• Monthly Payment Pre-Authorization
• One-Time Payment Pre-Authorization
• Education Status Update

If you are also covered by group insurance, send all claims to the insurance company first, then submit any balance remaining to Quikcard for reimbursement within your plan's limitations.

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