Financing Tips

Unfortunately, economics often dictate what procedure a patient can or cannot have performed. We have a long-standing relationship with Care Credit, and MedicalFinancing.com which can get you financed for virtually any procedure. You can even fill out your application on-line, and one of their agents will contact you with an answer within 24 hours Don’t let economic worries dictate what you can or cannot accomplish, we can help you!

If you have a specific question about financing give us a call at (713) 790-1771 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it to send us an email.

Acquired Loan Solutions

IF applying with a co-signer, please submit separate applications, and check here if the person on this form has the strongest credit standing.
A co-applicant is helpful, where the patient has limited or no credit history, damaged credit, and/or a credit score below 630.

First Name *

Last Name *

Date Of Birth *

Social Security No. *

Mother's Maiden Name *

Your Email Address

Address *

City *

State *

Zip Code *

Home Phone*

Work Phone *

Cell Phone *

Employer *

Years / Months with employer *

Credit Line Requested *

How Many Cars / Trucks Do You Own *

How Many Boats / RVs Do You Own *

How Many Student Loans Do You Have *

How Many Personal Loans Do You Have *

Married Yes No

Have You Had a Bankruptcy *

Income *

per Month Year

Major Credit Card Reference (NOT Check or Debit Card)

Credit Card No. (Your Card Will NOT Be Charged)

Inorder to submit your application you must read and agree to the following policy terms and conditions. Use the scrollbar to see the entire agreement.

Application Policies & Authorization To Release Private Information  I understand it is a criminal offense, to 1) use another person’s credit information or sign another person’s name to obtain this loan, 2) to submit false and/or misleading information on the credit application, 3) to confirm current employment, when in fact you are currently unemployed or have been notified of job termination on an immediately upcoming date, 4) to accept a loan for the payment of surgery expenses, when in fact you are in the process of, or are planning to file, bankruptcy leading to default of the loan obligation for financial services from the financial institution. I hereby state under the penalty of perjury, I have not committed any of the offenses stated above, and understand that I may be subject to civil action for any attempt to defraud and/or malign AcQuired Loan Solutions (AcQuired) and/or the lenders, and/or breach this Agreement in any manner. I understand too, I am responsible for all charges incurred under its terms, should I choose to accept or use any credit account offered as a result of this application. I affirm to be at least 18, and a U.S. Citizen and/or resident, and that I have the capacity and authorization to submit this application and accept financial services offered as it result. In accordance with all current standards and requirements regarding privacy and confidentiality I hereby allow the release of the above information to AcQuired, and authorize, request and empower AcQuired and its agents to apply for, secure and accept credit lines and terms and conditions on my behalf via phone, fax or online service, and or to provide referral and/or counseling services in their efforts to help me achieve my goal as above. I also authorize AcQuired and/or its agents to monitor and/or record calls, verify information I provide, obtain my credit report if necessary, and share to the extent permitted by law this information with others as necessary in their efforts, and I instruct lending sources to consider this application a duplicate if received within the past ninety days. I understand AcQuired is an independent marketing/processing company, not a lender, and entirely separate from any lender, engaged in the business of providing the above services, and therefore neither approves nor denies applications, sets interest rates, terms or plan/program fees, nor discriminates against any person for any reason. I understand too, credit approval can be subject to verification of employment, income and identification, that Lender and Plan fees are common in patient financing, and that I may be responsible for any such fees, which are disclosed in writing, and can be included in the amount financed, where lender authorized, to avoid an out-of-pocket expense prior to cosmetic services. I understand also, I am responsible for a one-time one hundred fifty dollar fee to AcQuired, if and only, their efforts result in a credit offer, that I am not obligated to accept or use any offer they may secure, and that I my cancel any such offer(s) at my discretion, with no penalty imposed by AcQuired. In other words, I understand AcQuired will be acting as a broker to submit my application to lenders. I understand also I am responsible for a one-time, one hundred fifty dollar fee to acquired, when their efforts result in a credit offer. If AcQuired obtains a bona fide commitment under the terms and conditions outlined above, I understand I am obligated to pay the one hundred fifty dollar processing fee even if I choose not to complete the loan transaction. I understand the above fee is being charged solely by AcQuired, and is that it is neither associated with, nor being paid to, any credit issuer or financial institution. I understand further, prices quoted by providers for cosmetic medical and/or dental procedures typically reflect the Cash discounted price, and that prices can vary among practices both locally and regionally. I understand, unsecured personal loans have a higher risk of default than any other type of loan, because there are no “goods” (car, boat, furniture, etc.) for the lender to repossess and resell to someone else should the borrower fail to pay, nor can the lender require a medical/dental provider to refund payment for purchases or services rendered, where the funds were paid directly to the borrower. Accordingly, I understand approval criteria for unsecured personal loans for elective medical/dental services is more rigid, and that interest rates are generally higher than those of credit unions and commercial lenders for retail purchases. I understand further, eligibility for these loans can be limited to employed persons with established credit history, and that applicants with well established and positive credit history have a greater chance of being approved, and experience lower interest rates and costs, as their risk of default is statistically low. Conversely, I understand, applicants with minimal Income and/or Credit History, High Debt-To-Income Ratio, High Balances, Low FICO Scores, History of Open Collections, Charge-Offs, Late Pays, and Past Dues, Excessive Obligations, Recent Bankruptcy, Judgments, Credit Counseling and Credit Settlement have less chance of being approved, and/or experience higher interest rates and costs, as their risk of default are statistically higher. In an effort to help offset the costs of risk lenders experience with these loans, I understand fees of from five to twenty percent or less are common in patient financing, and that I may be responsible for any such fees, which can be included in the amount financed, where lender authorized. I understand, as a national average, about only fifty percent of applications for patient financing are approved without a co-applicant, that interest rates are typically based on the Prime rate plus “risk” as perceived by the lender, and that interest rates of from nine to twenty-six percent are typical for standard plans, whereas lower and zero percent interest rates are typically promotional plans, subject to approval, availability and provider participation, and that their default criteria can be less forgiving, as determined by individual lenders offering them. I have read and/or understand and accept the terms of this application, agree to save and hold harmless AcQuired and its representatives from any and all claims and/or actions, including but not limited to attorney’s fees and costs connected in any manner to this application, and I affirm the information contained to be true and submitted by the person named herein whether or not signed. If the meaning of any portion of this Agreement differs in interpretation, in any language other than English, the meaning as written in English shall be the considered meaning.

I have read and agree to the application policies & authorization to release private information.

Check here to show that a co-signer will be submitting a form.

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