W9 Form

Reimbursify will send a signed W9 form on your behalf when required by certain insurance companies. Don’t worry, this is not for tax reporting purposes. Click here if you are wondering why a signed W9 is required.

When you submit the information below, we will send you a pre-filled W9 form to electronically sign and return to us with just a few mouse clicks. 

Once we have your signed W9 form on file, we will include a copy of it when filing claims for visits to your practice to the insurance companies that require it.