Submit a Woman's Choice Program Claim

To file a claim for the Woman’s Choice Program, the patient must be accompanied by their surgeon and submit the required documentation as follows: 

• Woman's choice program claim form signed by patient and surgeon.

The following information is required to verify eligibility for reimbursement. 

• Proof of explantation: e.g., a document from the clinic/surgeon that refers specifically to an explantation performed on a specific date. 
• Invoices of the explantation surgery.

See the Terms and Conditions.

 

Submit a claim through this form with the requested documents.

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