Payment Plan Application

The Payment Plan
Through the ColonoscopyAssist Payment Plan Fund, patients can receive a 3 month loan allowing them to split up payment for their colonoscopy into installments. There is no interest accrued if paid on time and no credit check is required.

Instant Pre-Approval
Patients interested in getting a payment plan can complete the Instant Pre-Approval form to see if they would be approved.
It takes less than 2 minutes to complete and an approval decision is given in less than 60 seconds.

To apply for a payment plan,  the applicant must complete the payment plan application form. An approval decision is given within 48 hours.

The following eligibility requirements are applicable for the applicant. The applicant does not have to be the patient.

To be eligible for the payment plan, the applicant must :
1) have steady income
2) must have a valid debit or credit card to make payments. The debit or credit card must have sufficient funds or credit limit for the expected monthly payment.
3) be able to provide the following documents :

  • Prior 2 months statement for the Debit or Credit card they intend to use.
  • A Valid State Issued ID. (Driver License or State ID)
  • Proof of Social Security Number

About the Payment Plan Fund
The ColonoscopyAssist Payment Plan Fund was made possible by a donation from the Poonawala Family. The fund allows the program to finance approximately 50 colonoscopies at any given time.


Get Pre-Approved
Apply For Payment Plan