MedPlan Credit, LLC

FINANCING APPLICATION FORM

Apply for healthcare financing in seconds.

In an effort to make care accessible to all of our patients regardless of their financial situation, we have partnered with MedPlan Credit to provide patient-friendly payment plans that can fit most budgets. Unlike credit cards, MedPlan provides installment loans with a fixed interest rate, much lower than credit card rates. For a small one time enrollment fee, MedPlan loans provide affordable payments that can be spread out monthly to fit your budget to ensure that you get the care that you need.




  • 6
  • 12
  • 18
  • 24
  • 30
  • 36
  • 42
  • 48
  • 54
  • 60

Payments over months selected.

Estimated Monthly Payments: $

Estimated One Time Enrollment Fee: $

Are you currently employed?
Retired, SSI, Disability or Unemployed is not considered valid employment

Please Enter Card Information
No charge to your card until your loan process is complete with authorized signature.

I understand that I am applying for credit and I hereby authorize Medplan Credit to obtain my credit information.
 I attest this is true and correct information.
 Incorrect Information may result in denial of loan application and forfeiture of enrollment fee.


Please provide the Cosigner's Name and Email address. An email will be sent to them containing a link to complete the application.


Applicant
Cosigner