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Procedure Scheduling Forms
What would you like to do?
I want to make a payment
I want to apply for a payment plan
Help keep costs low
Help keep costs low by making a payment by check or debit card when possible
Check / Money Order
Debit Card / Credit Card
To make a payment via Check or Money Order, please mail a payment to :
The ColonoscopyAssist Program
8150 Springwood Dr, Suite 190
Irving TX 75063
Checks should arrive at least 7 days prior to the scheduled appointment date.
Cash payments are not accepted at this time.
Do you already have a CareCredit Account?
You will need to first apply for a CareCredit account.
Once approved, you can return to this page to make a CareCredit Payment.
You will be redirected to the Care Credit Website to make a payment
When asked for Provider Account Number, please enter 99999 or 00000.
Go to CareCredit Payment Site
Is your scheduled appointment date more than 8 days away from today?
Unfortunately, its too late to apply for a payment plan.
ColonoscopyAssist can not accept new payment plan applications for procedures scheduled within 8 days.
CareCredit is recommended for patients with an
above average credit score
. You are able to
finance 100% of your procedure cost without paying anything upfront
With CareCredit you can choose between the following plans :
1) 6 month interest free
2) 24 month interest bearing @ 14.9% APR
3) 36 month interest bearing @ 14.9% APR
4) 48 month interest bearing @ 14.9% APR
A ColonoscopyAssist Payment Plan is recommended for patients that would not qualify for a CareCredit plan.
The plan requires 50% to be paid upfront with the balance to be paid over 3 months. The plan is interest-free.
Which Payment Plan would you like to apply for?
ColonoscopyAssist Payment Plan
Apply For Payment Plan
You may read our
Cancellation and Refund Policy
prior to making any payments.
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