Patient Form

How to find a Provider
OR Get your local doctor
or provider signed up

Thank you for your interest in iCare Financial's no credit check Financing program.
Our program allows you to be set up on monthly payments through your local iCare provider. If you were directed here by your provider's website please do one of the following:

STEP 1: Fill out your information (All fields are REQUIRED)

STEP 2: Pick one of the following:*

ALREADY HAVE A DENTIST / VETERINARY / AUTO REPAIR/ MEDICAL PROVIDER?

ARE YOU A CURRENT PATIENT/CUSTOMER OF THE BUSINESS YOU LISTED?

YESNO