Claim Form

Get started by downloading the PDF.
Download the Galen Claim Form to start the claims process with Galen Insurance Company.

Filing a Claim

  • Download and print, the Galen Claim Form.
  • Complete claim form and have notarized.
  • Fax completed and notarized claim form to 314-721-2377. Completed claim forms will be reviewed and you will be contacted. Reference subsection A of 143 in your individual policy for further clarification.
  • Place patient records in a secured location. It is imperative to maintain a chain of custody for these records, ensuring that they are not altered or destroyed. Any further changes made to a patients file will only serve to complicate the claims process.

Please fax completed forms to 314-721-2377.