Follow the steps to successfully complete the Verification Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editing tool.
2. Begin by entering the CICB File Number in the designated field. This number is essential for linking your treatment with your claim.
3. Next, fill in the Claimant Name field with the full name of the individual who is making the claim.
4. In the Treatment Provider’s Name field, provide the name of the individual or organization offering the treatment.
5. The Treatment Provider’s Signature must be included, confirming the provider's authorization and consent for the treatment detailed.
6. Specify the one-month period ending date on the form. This date marks the end of the treatment timeframe being claimed.
7. For each treatment session, record the Treatment Date and Type of Treatment in the provided columns. Ensure to fill in the number of minutes per session.
8. The Claimant’s Signature is required at the end of each treatment session, confirming their acknowledgment and approval of the treatment rendered.
9. Once all sections are filled out completely, ensure to review for accuracy before proceeding.
10. Finally, save the changes, and you have the option to download, print, or share the completed form as necessary.

Complete your Verification Form online today to ensure timely processing of your treatment expenses.