To request a reimbursement from the Center for Care Innovations (CCI), please complete the following reimbursement request within 30 days of original expense date.
Each line item must have corresponding receipt with proof of purchase (i.e. last four digits of the credit card used to complete the transaction). If you are submitting reimbursement for mileage, please complete this mileage form, input the total reimbursement amount as an itemized expense below and upload the completed mileage form in lieu of a receipt.
For any questions regarding your reimbursement, please contact email@example.com. You will be contacted by CCI if there are any questions or missing components for the request. Payment will be delivered 4-6 weeks after your request is successfully submitted.