Welcome to a new way to pay your healthcare costs: a single monthly statement for your out-of-pocket costs with built-in, 0% interest financing... no credit check needed! Use our payment platform to make your healthcare more affordable so you can access the care you need when you need it.
Learn more about our payment model and what to have on-hand for this form at https://www.simplepayhealth.com/payments-made-easy/
If you have any questions or are unable to complete this form, please reach out to HealthValet@SimplePayHealth.com or 800-606-3564 for assistance.
Let’s start by getting to know you. Please enter the Primary plan member’s information below: