New Application

  • ApplicantInformation
  • Review & Sign
  • Result

Add a co-applicant below to continue with a full application, which includes a hard inquiry on the applicants' credit report.

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Applicant Information

This email address allows CareCredit to communicate with your patient/client regarding his/her account.
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Alimony, child support or separate maintenance income need not be disclosed unless relied upon for credit.

Co-Applicant Information

This email address allows CareCredit to communicate with your patient/client regarding his/her account.

123 Main Street
Kettering, OH, 45419

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Alimony, child support or separate maintenance income need not be disclosed unless relied upon for credit.