---
title: Wellness Program Insurance Reimbursement Form Template | Paperform
description: Free form template for gyms, trainers, and wellness centers to support clients with HSA/FSA reimbursement, superbill generation, service codes, and receipt formatting.
url: "https://paperform.co/templates/wellness-program-insurance-reimbursement-form"
type: static
generatedAt: "2026-03-28T00:45:34.834Z"
---

[← Back to free form templates](/templates/)    ![Wellness Program Insurance Reimbursement Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/wellness-program-insurance-reimbursement-form.png)
    [Preview](https://_preview.paperform.co/ai-template/wellness-program-insurance-reimbursement-form) [Use this template for free](/create?ai-template=wellness-program-insurance-reimbursement-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Industry-Specific Forms](/templates/category/industry-specific/) [Fitness & Wellness](/templates/industry/fitness-wellness/) [Health Coach](/templates/role/health-coach/)[Physical Therapist](/templates/role/physical-therapist/)[Fitness Trainer](/templates/role/fitness-trainer/)[Nutritionist](/templates/role/nutritionist/)[Massage Therapist](/templates/role/massage-therapist/)     About this free form template
### Simplify Insurance Reimbursement for Your Wellness Clients

If you run a gym, personal training studio, or wellness center, you know how often clients ask: "Can I use my HSA or FSA for this?" This **Wellness Program Insurance Reimbursement Form** helps you support those clients by generating professional superbills, tracking eligible services, and providing clear submission guidance—all without adding hours to your admin workload.

#### Built for Fitness & Wellness Professionals

This template is designed for personal trainers, physical therapists, wellness coaches, yoga studios, Pilates instructors, and fitness facilities that offer medically necessary or preventative wellness services. It captures everything needed for a compliant insurance superbill: client details, provider credentials, service dates, CPT or custom service codes, diagnosis codes (if applicable), and itemized receipts.

Instead of manually creating documents for each client request, you can collect all the necessary information in one branded form and use **Paperform's calculation engine** to auto-generate totals, format line items, and prepare submission-ready documentation. Clients leave with exactly what they need to submit to their insurance provider or benefits administrator.

#### How Paperform Powers Reimbursement Workflows

Paperform's conditional logic lets you tailor the form based on service type—whether it's one-on-one training, group classes, nutrition counseling, or massage therapy. You can automatically show or hide fields for diagnosis codes, referring physician details, or additional documentation uploads depending on what the client selects.

Once submitted, you can trigger **Stepper workflows** (stepper.io) to route the information to your billing team, generate a PDF superbill, send a confirmation email with next steps, or log the request in your CRM or practice management software. This keeps your reimbursement process organized, compliant, and client-friendly.

#### Support Your Clients, Differentiate Your Services

Offering insurance reimbursement support isn't just helpful—it's a competitive advantage. Clients are more likely to invest in ongoing wellness services when they know they can offset costs through their HSA, FSA, or insurance plan. This form makes it easy to deliver that experience professionally and at scale.

Trusted by over 500,000 teams worldwide and SOC 2 Type II compliant, Paperform gives fitness and wellness businesses the tools to streamline operations, improve client satisfaction, and grow with confidence.
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