PATIENT LOAN APPLICATION TERMS
All applicants must be 18 years of age to apply. Must have a U.S. address, a valid SSN# a minimum annual income of $12,000.00, a FICO Score of 600, 2 established trade lines and Bankruptcy at least 3 years old to apply. Please ensure all fields below are completed.
Depending on the loan program you qualify for, a revolving credit account or a credit card may automatically open in your or your Co-Borrower’s name. If you receive a credit card instead of a credit account the terms of the credit card include a 1st time fee to 1st Choice Funding of 9% of the amount you are approved for. This amount will be the 1st Transaction on your account. An annual renewal fee of $25.00 is added upon the anniversary of the account.
A third option to financing is a $6,500.00 cap with a down payment requirement of 25% which is direct deducted if you are approved and you accept the contract offered.
As an applicant it is 1st Choice Funding's goal to ensure your application is approved as long as you meet the minimum qualifying criteria. In order to do so it may be necessary to utilize multiple sources to achieve financing if you are declined. If such occurs we offer this as an added service at no further cost. In the event none of our financing sources approves your request, please re-apply with a co-signor if not provided initially.
Additionally 1st Choice Funding shall send via email our FICO-911 Credit Restoration Services and other money saving advise as a member of our patient services.
If you have any questions please email; information(.)services@1stchoicefunding.com. If you are in complete agreement with the terms outlined herein, please complete the following application.
CONTACT INFORMATION
First Name*
Last Name*
Application Type*
Substitute Borrower** or Co-Applicant
Are you applying with a Substitute Borrower** or Co-Applicant?*
Substitute Borrower/Co-applicant Relationship
Referred By
Reference Number
2010 CPT Codes _____________________________________________
PATIENT APPLICATION FEE $50.00
BANK NAME
BANK ADDRESS
ROUTING NUMBER
ACCOUNT NUMBER
PLEASE ENTER CPT CODE OR
SELECT MEDICAL PROCEDURE OR SERVICE
Category 1 - Age Management
Nursing Home Care
In Home Healthcare Medical Services
Rehabilitation Services
Hearing Aids
To Enroll as a Provider Please Click Here
Patients Applying For Financing Please Click Here
For Questions Please Email: information(.)services@1stchoicefunding.com
Category 2 - Body Contouring
Abdominal Etching
Arm Lift
Brazilian Butt Lift
Buttock Implants
Calf Implants
Fat Grafting/Transfer
Labiaplasty / Vaginal Rejuvenation
Laser Liposuction
Liposuction / Liposculpture
SmartLipo
Thigh / Buttocks Lift
Tummy Tuck
Breast Enhancement
Beast Asymmetry
Breast Enlargement
Breast Implant Revision
Breast Lift
Breast Reconstruction
Breast Reduction
Male Breast Reduction
Male Pectoral Implants
Nipple Correction
Tuberous Breast Correction
For Questions Please Email: information(.)services@1stchoicefunding.com
Category 3 - All Chiropractic Services
Category 4 - All Dentistry / Cosmetic Dentistry
Dentures
Orthodontics
Tooth Extraction
Category 5 - Facial Plastic Surgery
Brow Lift / Forehead Lift
Buccal Fat Pad Extraction
Cheek Implants
Chin Implants
Dimple Creation
Ear & Earlobe Surgery (Otoplasty)
Eyelid Surgery
Facelift
Facial Fat Grafting
Hair Restoration
Lip Augmentation
Neck Lift
Neck Liposuction
Nose Surgery (Rhinoplasty)
For Questions Please Email: information(.)services@1stchoicefunding.com
Category 6 - Fertility Services
Invitro
Tubal Ligation Reversal
Vasectomy
Vasectomy Reversal
Category 7 - Hand Rejuvenation
Category 8 - MedSpa Services
BOTOX® Cosmetic Injection
Cellulite Treatment
Fraxel
Injectable Fillers
Laser Hair Removal
Laser Skin Resurfacing
Spider Vein Treatment
Tattoo Removal
Category 9 - "Other Procedures"
Rehabilitation Services
Addictions Treatment
Alcohol Abuse Treatment
Drug Detox
Eating Disorder Treatment
Smoking Treatment
Sports Medicine
Stem Cell Treatment
Urology
Cataract Surgery
Lasik
Vision Correction
For Questions Please Email: information(.)services@1stchoicefunding.com
Category 10 - Weight Management
Weight Loss Surgery
Bariatric Surgery
Body Lift After Gastric Bypass
Duodenal Switch
Gastric Bypass Surgery
LAP BAND
Panniculectomy
REALIZE™ Band
Roux-en-Y Gastric Bypass
Vertical Sleeve Gastrectomy
For Questions Please Email: information(.)services@1stchoicefunding.com Medical Proceedures Under Patient Financing
Category 11 - General Patient Services
Abdominal hysterectomy
Abdominal ultrasound
ACTH stimulation test
Adenoidectomy
Adjunctive therapy
Adjuvant therapy (AD-joo-vant)
Amniocentesis
Amputation (am-pyoo-TAY-shun)
Anastomosis (an-AS-ta-MO-sis)
Androgen suppression / androgen ablation
Anesthesia
Angiography (an-jee-AH-gra-fee)
Angioplasty
Ankle brachial index test
Antibody therapy
Appendectomy (ap-pen-DECK-toe-me)
Arteriography (ar-TEE-ree-AH-gra-fee)
Arthroscopy
Balloon angioplasty
Barium enema
Barium swallow
Biliary
Biofeedback
Biological therapy (by-o-LAHJ-i-kul)
Biopsy (BY-op-see)
Blepharoplasty
Bone marrow biopsy (BY-op-see)
Bone marrow transplantation (trans-plan-TAY-shun)
Bone scan
Brachytherapy (BRAKE-ih-THER-a-pee)
Breast-conserving surgery
Bronchoscopy
Bypass
Camera pill
Capsule endoscopy
Cardiac catheterization
Carotid endarterectomy
Carotid ultrasound exam
Castration
Cataract surgery
CAT scan
Catheterization
Cauterization (KAW-ter-ih-ZAY-shun)
CBC
Celioscopy
Cerebral angiography / cerebral arteriogram
Cesarean section
Chamberlain procedure
Chemoembolization
Chemotherapy
Cholecystectomy
Chorionic villus sampling
Colectomy (ko-LEK-toe-mee)
Colonoscopy (ko-lun-AHS-ko-pee)
Colostomy
Colposcopy (kul-PAHS-ko-pee)
Combination chemotherapy
Complete blood count
Complete hysterectomy
Computed tomography (tuh-MAH-gra-fee)
Computed tomography angiogram (CTA)
Concurrent therapy
Cone biopsy
Continuous infusion
Conventional therapy
Coronary angiography
Coronary angioplasty
Coronary artery bypass operation
Craniotomy (kray-nee-AH-toe-mee)
Cryosurgery (KRYE-o-SIR-jer-ee)
Cryotherapy
C-section
CT scan
Curettage (kyoo-reh-TAHZH)
CVS
Cystectomy (sis-TEK-toe-mee)
Cystoscopy (sist-OSS-ko-pee)
D&C
Da Vinci Robotic Surgery®
Decortication (de-KOR-tih-KAY-shun)
Defibrillation
Dermabrasion
DEXA Scan
Dialysis (dye-AL-ih-sis)
Diathermy (DYE-a-ther-mee)
Digital rectal examination
Dilation and curettage (dye-LAY-shun and kyoo-reh-TAHZH)
Discectomy
For Questions Please Email: information(.)services@1stchoicefunding.com
Distal pancreatectomy
Ductal lavage
Electrocardiogram
Echocardiography
EGD
EKG
Electrocardiogram
Electroencephalogram (EEG)
Electromyography
Electron beam computed tomography (EBCT)
Electronystagmogram
Embolization (EM-bo-lih-ZAY-shun)
Endocrine therapy
Endometrial ablation
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic therapy
Endoscopic ultrasound
Endoscopy (en-DAHS-ko-pee)
ENG
Epidural block
Episiotomy
ERCP
ERT
Esophagoscopy (eh-sof-a-GAHS-ko-pee)
Esophagogastroduodenoscopy
EGD
Esophagram (eh-SOF-a-gram)
Excisional biopsy (ek-SI-zhun-al BY-op-see)
External-beam radiation (ray-dee-AY-shun)
Extracorporeal shock wave lithotripsy
Fecal occult blood test (FEE-kul o-KULT)
Fine-needle aspiration
Fluoroscopy (floor-AHS-ko-pee)
fMRI
Fulguration (ful-gyoor-AY-shun)
Functional magnetic resonance imaging
Gastrectomy (gas-TREK-toe-mee)
Gastroscopy
Gene therapy
General anesthesia (an-es-THEE-zha)
Genetic testing
Grading
Helical computed tomography
Hemorrhoidectomy
Herniorrhaphy
Hormonal therapy
Hormone replacement therapy
Hyperthermic perfusion
Hysterectomy (hiss-ter-EK-toe-mee)
Hysterosalpingography
ICD implantation
Ileostomy (il-ee-AHS-toe-mee)
Immunoscintigraphy
Immunosuppression
Immunotherapy (IM-yoo-no-THER-a-pee)
Implant radiation (ray-dee-AY-shun)
Incisional biopsy (in-SI-zhun-al BY-op-see)
Infusion
Inguinal orchiectomy (IN-gwin-al or-kee-EK-toe-mee)
Intracarotid infusion
Intraepithelial (in-tra-eh-pih-THEEL-ee-ul)
Intrahepatic (in-tra-hep-AT-ik)
Intraventricular infusion
Irradiation (ih-RAY-dee-AY-shun)
Joint replacement surgery
Keratectomy
Keratotomy
Laboratory test
Laminectomy
Laminoplasty
Laminotomy
Laparoscopic cholecystectomy
Laparoscopy (lap-a-RAHS-ko-pee)
Laparotomy (lap-a-RAH-toe-mee)
Laryngoscopy (lair-in-GOS-ko-pee)
LEEP
Lipoprotein Profile
Lithotripsy
Lobectomy (lo-BEK-toe-mee)
For Questions Please Email: information(.)services@1stchoicefunding.com
Loop electrosurgical excision procedure
Lower GI series
Lumbar puncture
Lumpectomy (lump-EK-toe-mee)
Lymphadenectomy
Lymphangiography (lim-FAN-jee-AH-gra-fee)
Magnetic resonance angiography (MRA)
Magnetic resonance imaging (MRI)
Mammogram (MAM-o-gram)
Mastectomy (mas-TEK-toe-mee)
Mediastinoscopy (MEE-dee-a-stin-AHS-ko-pee)
Metabolic therapy
Microwave therapy
Minimally invasive surgery
Mohs therapy
MRI
Myectomy
Myelogram
Myolysis
Myomectomy
Needle biopsy
Neoadjuvant therapy
Nephrectomy (nef-REK-toe-mee)
Nephrotomogram (nef-ro-TOE-mo-gram)
Nerve block
Neurosurgery
NMRI
Nuclear medicine scan
Oophorectomy (o-o-for-EK-toe-mee)
Open heart surgery
"Coronary Bypass Surgery" "Transplants")
Ostomy (AHS-toe-mee)
Ovarian ablation
Palliative therapy
Palpation
Pancreaticoduodenectomy
Pap test
PCA
Pelvic laparoscopy
Percutaneous (per-kyoo-TAY-nee-us)
Percutaneous transluminal coronary angioplasty
PTC
Perfusion
PET scan
PET-CT scan
Pheresis (fer-E-sis)
Photodynamic therapy (PDT)
Photorefractive keratectomy
Pneumonectomy (noo-mo-NEK-toe-mee)
Port
Positron emission tomography scan
Proctosigmoidoscopy (PROK-toe-sig-moid-OSS-ko-pee)
Prostatectomy (pros-ta-TEK-toe-mee)
Proton magnetic resonance spectroscopic imaging
PTCA
Pump
Quadrantectomy (KWAD-ran-TEK-toh-mee)
Radial keratotomy
Radiation Therapy
Radical cystectomy (RAD-ih-kal sis-TEK-toe-mee)
Radical lymph node dissection
Radical mastectomy (RAD-ih-kal mas-TEK-toe-mee)
Radical prostatectomy (RAD-ih-kal pros-ta-TEK-toe-mee)
Radiofrequency ablation
Radionuclide scanning
Radiosurgery
Radiotherapy (RAY-dee-o-THER-a-pee)
Reconstructive surgery
Refractive surgery
Resection (ree-SEK-shun)
Salpinectomy
Salpingo-oophorectomy (sal-PIN-go o-o-for-EK-toe-mee)
Scans
Sclerotherapy
Sepsis (SEP-sis)
Sigmoidoscopy (sig-moid-OSS-ko-pee)
Somnoplasty
Sonogram (SON-o-gram)
Spinal fusion
Spinal tap
Spiral CT scan
Splenectomy (splen-EK-toe-mee)
Stent
Stereotactic biopsy (STAIR-ee-o-TAK-tik BY-op-see)
Stereotactic radiosurgery
Steroid therapy
Stress test
TENS
Thallium stress test (nuclear stress test)
Thermal ablation
Thoracoscopy
Thoracotomy (thor-a-KAH-toe-mee)
Thyroidectomy (thigh-roid-EK-toe-mee)
Tilt table test
Tomography (tuh-MAH-gra-fee)
Total hip replacement
Total knee replacement
Tracheostomy (TRAY-kee-AHS-toe-mee)
Transabdominal ultrasound
Transcutaneous electric nerve stimulation
Transplantation
Transrectal ultrasound
Transurethral resection (TRANZ-yoo-REE-thral ree-SEK-shun)
Transvaginal ultrasound
Ultrasound test
Upper GI series
Urostomy (yoo-RAHS-toe-mee)
Uterine ablation
Uterine fibroid embolization (UFE)
Vaginal hysterectomy
Vertebroplasty
Voiding cystourethrogram
X-ray
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