Medical Practice Merchant Services Application

Managing payments in a medical practice requires more than just a standard merchant account—you need a solution that understands the unique complexities of healthcare billing, patient payment plans, insurance copays, and recurring charges, all while maintaining the highest standards of data security.

This Medical Practice Merchant Services Application template is designed specifically for healthcare providers who need to set up payment processing that works with their practice management workflow. Whether you're a small clinic, dental office, or multi-provider practice, this application captures everything merchant services providers need to evaluate your practice and set up the right payment infrastructure.

Why medical practices choose Paperform for payment applications

Medical practices face unique challenges when accepting payments: varying transaction types (copays, deductibles, payment plans, elective procedures), the need for secure recurring billing, and strict compliance requirements. This template helps you apply for merchant services that address these specific needs.

With Paperform, you can customise this application to match your practice's branding, embed it directly on your website, and automatically route submissions to your financial team or merchant services provider. The conditional logic ensures applicants only see relevant questions based on their practice type and payment needs, creating a streamlined experience.

Once approved, you can use Papersign (papersign.com) to send merchant agreements and contracts for secure eSignature, keeping all documentation linked to the original application. And with Stepper (stepper.io), you can automate the entire approval workflow—routing applications for review, triggering background checks, updating your CRM, and notifying your team when new merchant accounts are ready to activate.

Perfect for healthcare payment processing needs

This template is ideal for medical practices, dental offices, specialty clinics, physical therapy centers, urgent care facilities, and other healthcare providers who need to accept patient payments securely and efficiently. It covers everything from basic practice information to specific payment processing requirements like payment plan management, insurance copay collection, and recurring billing for ongoing treatments.

By using Paperform's secure, SOC 2 Type II compliant platform, you ensure patient and practice data is protected throughout the application process, setting the foundation for payment processing that meets healthcare compliance standards.