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You can complete the online application in less than 5 minutes.

Any questions just contact us on 1800 810 950 or email info@medipay.com.au.

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

Procedure


Procedure

Please choose your procedure category*
Please choose your procedure*
If you can't see your procedure, choose the 'Other' option.
Do you own the Pet?*
You must be the Pet Owner to continue
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Must be between $2,000 and $30,000
We will use this for all official communication with you.
We'll send you important notifications via SMS
You must review and agree to our Privacy Policy and Credit Reporting Policy before proceeding.*
Will a parent or your spouse help you make the repayments?*
Enter their full name here.
You are required to insert their email to complete the application. We'll send them an email with a link to complete the application once you submit this form. If your co-applicant has already completed an application please insert their email address so we can attach your application to theirs as a joint application.
Have you decided on a doctor/clinic for your procedure?*
Or if the procedure is for your pet then have you decided on a vet?
If for your pet insert the name of vet or clinic.
When do you think you will need the funds?*
An estimated date is fine

Employment


Employment Details

Employment status*
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About your employer

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How long have you worked here?*
Please include area code. We'll use this to confirm your employment status.

About your previous employer

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Please include area code

Self-employment details

How long have you been self employed?*
As part of verification we will ask you to provide your two most recent ATO Notice's of Assessment

Address details



Your Address Details

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Address*
How long have you lived at this address?*
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Previous address*
What is your home ownership status – i.e. do you own or rent your home?
Pick one option that best applies to you. If you're unsure, choose 'Other'
Relationship status*

Your Income & expenses



Your Income & Expenses

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Don't include commissions, super or bonuses here – just your fixed base salary. Minimum gross annual salary is $25,000. (ONLY insert numbers - NO commas, fullstops or dollar signs)
How often do you get paid?*
Do you receive a payment from Centrelink?*
Including Age Pension, Disability Support Pension and Family Tax Benefit or any other Centrelink payment
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Do you have any other source of income?*
Like bonuses, commission, interest, dividends or a second job. Do not include rental income from investment property as this is asked for below.
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Don't include rental income here
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Include all your household monthly living expenses that you pay each month. Include: Childcare; Clothing & Personal Care; Education; Groceries; Insurances; Medical & Health Care; Travel, Recreation & Entertainment; Communications; Transportation; Utilities and any other household costs. DO NOT include rent, mortgage or loan repayments since these are asked for in other fields.
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Include all your household monthly living expenses that you pay each month. Include: Childcare; Clothing & Personal Care; Education; Groceries; Insurances; Medical & Health Care; Travel, Recreation & Entertainment; Communications; Transportation; Utilities and any other household costs. DO NOT include rent, mortgage or loan repayments since these are asked for in other fields.
What percentage of your total household monthly living expenses does your spouse or partner pay each month?
How often do you pay rent or mortgage on your home?*
This is only about the home you live in - not investment properties
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This is only about the home you live in - not investment properties
What percentage of your rent or mortgage does your spouse or partner pay each time?
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How much is your home currently worth (estimate)?
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Latest balance owing on your home loan
Do you expect any significant change to your financial situation over the next 6 to 12 months that would ADVERSELY impact your ability to meet loan repayments?*

Your assets & liabilities


As a responsible provider of payment plans, we need to ensure our payment plans are offered only to those that can afford them. This is good for both you, and us. The questions below help us understand your financial situation better.

Do you own any investment property?*
Other than the home you live in
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Property 1: Are you making mortgage repayments on this property?
Only for this property
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Only for this property
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Latest balance owing for this property only
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Property 2: Are you making mortgage repayments on this property?
Only for this property
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Only for this property
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Latest balance owing for this property only
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Property 3: Are you making mortgage repayments on this property?
Only for this property
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Only for this property
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Latest balance owing for this property only
One per line
Do you own any other non-property assets?*
Like a car, shares or any other major items.
If you're unsure, include it anyways.
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Do you have credit cards?*
Please include storecards e.g. MYER, DJs, Gem Visa, GO MasterCard
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If you pay it off in full at the end of each month, enter 0, otherwise enter the current balance owed
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If you pay it off in full at the end of each month, enter 0, otherwise enter the current balance owed
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If you pay it off in full at the end of each month, enter 0, otherwise enter the current balance owed
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If you pay it off in full at the end of each month, enter 0, otherwise enter the current balance owed
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If you pay it off in full at the end of each month, enter 0, otherwise enter the current balance owed
Please include all storecards e.g. Myers, DJs, Gem Visa, GO MasterCard
Do you have any other debt?*
Like unpaid overdrafts, car loans, personal loans, etc.
Eg: Overdraft, personal loan, car loan, etc.
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Eg: 16000
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Eg: 800
Eg: Overdraft, personal loan, car loan, etc.
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Eg: 16000
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Eg: 800
Eg: Overdraft, personal loan, car loan, etc.
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Eg: 16000
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Eg: 800
Eg: Overdraft, personal loan, car loan, etc.
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Eg: 16000
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Eg: 800
Eg: Overdraft, personal loan, car loan, etc.
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Eg: 16000
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Eg: 800
The type of debt, the total amount and monthly repayments.

Your ID



Your ID

Date of birth*
Do you have an Australian driver's license?*
Driver's license state*
Include the number before your name with no spaces - 11 digits total
Medicare card sample
What colour is your Medicare card?*
What is the expiry (valid to) date on your Medicare card?*
How many dependants do you have*

Your declaration


Your Declaration

Are you an Australian citizen or Permanent Resident?*
Do you declare all the information that you have provided in this application to be true and correct?*
Do you give us consent to check your credit history and verify your identity?*
Do you give us consent to send you notices and documents electronically and signing documents electronically?*
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