Join PaySick Network - Provider Application

Why Partner with PaySick?

Faster Payments

Receive payments within 24 hours of treatment with our streamlined settlement process.

More Patients

Access our growing network of patients who can now afford quality healthcare.

Reduced Risk

PaySick assumes the credit risk - you get paid upfront, we collect from patients.

Provider Application

Complete the form below to join our network

Basic Information

Provider/Practice Name *

Provider Type *

Provider Group (if applicable)

Contact Information

Contact Email *

Contact Phone *

Physical Address *

City *

Province *

Postal Code *

Banking Information

Banking details are required for settlements. All information is encrypted and stored securely in compliance with POPIA.

Bank Name *

Branch Code *

Account Number *

Account Holder Name *

Practice Information

Average Monthly Patient Volume

Years in Operation

Services Offered

Terms & Conditions

I accept the PaySick Provider Terms & Conditions *

I consent to PaySick processing my information in accordance with POPIA *

I understand and agree to the commission structure (2-5% based on volume) *

Cancel

Application Submitted Successfully!

Thank you for your interest in joining the PaySick network. Our team will review your application and contact you within 2-3 business days.

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