Help lamar 02Gym-Reimbursement-FormExercise Facility Reimbursement Program Reimbursement Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your MetroPlusHealth ID Number, Last Name, First Name, and Middle Initial in the Member Information section. Ensure all details are accurate to avoid processing delays.
3. Fill in your complete address including City, State, and Zip Code. This information is crucial for correspondence regarding your reimbursement.
4. Specify the Six-Month Period Requested by entering the start and end dates in mm/dd/yyyy format.
5. In the Health Club Information section, provide the Gym/Health Club’s Name, City, State, Phone Number, and Amount Being Claimed. Double-check that these match your receipts.
6. Sign and date the form at the bottom to certify that all information is complete and accurate. Remember to include a Gym Representative’s Signature if required.

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