Private-practice psychologists and psychotherapists use this one-page SAAQ claim to be paid for a road-accident victim's psychology treatment. It records the billing period, the hours spent on the initial assessment and on treatment, and a day-by-day attendance calendar. The SAAQ asks for one each month per accident victim and first judges whether the fees relate to the accident and are relevant and necessary.
The psychologist or psychotherapist completes Sections 1 to 4 and signs the Section 5 declaration with their permit number. The accident victim, or their representative, signs beside it to confirm attending every listed session and to ask the SAAQ to pay the professional directly.
Download the current version from the source each time; forms change without notice.
Demande de remboursement de frais de psychologie
Request for Reimbursement of Psychology Fees
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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Every month. A note printed on the form says the SAAQ asks the psychologist or psychotherapist to send the reimbursement request monthly, and the SAAQ's forms page asks for one claim per accident victim each month. Each claim covers a billing period with from and to dates, and its attendance calendar has a row per month.
No. The form says only services actually given are reimbursable, so mark a missed session A in the attendance calendar and inform the SAAQ of the absence without delay. For the missed appointment itself, the form tells you to apply your usual policy with the patient.
No. The SAAQ publishes this form, like its other forms for psychologists and psychotherapists in private practice, in French only. You can fill the PDF on screen and then print and sign it, or print it and complete it by hand. Paper copies can be ordered from the SAAQ with its order form, 4048 30.