How to Fill Out and Submit the CareCredit Claim Form

The CareCredit appeal claim form is a one-page document you mail to Synchrony Bank to dispute a charge or appeal a previous decision on your CareCredit account. Send the completed form to CareCredit, PO Box 628407, Orlando, FL 32862-8407, and make sure it arrives within ninety days of the date on the notice CareCredit sent you.¹ The form has four sections: your personal information, the disputed transaction, your reason for the claim, and your signature.

When the Form Applies

Section C of the form lists four situations. Check every box that fits your dispute:¹

Products or services not received: you were charged for a procedure, treatment, or product that was never actually provided.
Missing refund: your healthcare provider promised a refund, but the credit never appeared on your account.
Unauthorized charges: you did not apply for a CareCredit card, or you did not authorize the specific transaction.
Inadequate disclosure of terms: you were not properly informed that you would owe interest if the balance wasn’t paid by the end of the promotional period, what your interest rate was, or that interest accrues from the purchase date during the promotional window.

That last category catches many cardholders off guard. CareCredit’s deferred-interest promotions charge retroactive interest on the full original purchase price if any balance remains when the promotional period ends. If nobody explained that to you at the provider’s office, this form gives you a path to challenge the resulting charges.

How To Complete Each Section

The form is short, but incomplete or unclear entries can get your claim denied.

Section A: Claimant Information

Print your full name, street address, apartment number if applicable, city, state, and zip code. Add your phone number, email address, and your CareCredit account number.¹ The account number appears on your card and on your monthly statements. Double-check it. A transposed digit can delay processing because the bank cannot match your claim to the right account.

Section B: Disputed Charge Information

Enter the date of the disputed transaction in month/day/year format and the dollar amount in dispute. Write in the name of the healthcare provider connected to the charge.¹ Pull these details directly from your billing statement so the date and dollar amount match exactly. If you are disputing more than one transaction, list each separately.

Section C: Basis for Claim

Check every applicable box from the four categories above. Below the checkboxes, write an explanation of why you believe the charges were improper. The form warns that skipping this explanation may cause your claim to be denied.¹ Keep it factual and specific. A strong explanation names the date you spoke with the provider, what was promised, and what actually happened. Vague statements like “I don’t think I should have been charged” give Synchrony nothing to investigate.

Section D: Signature

Sign and date the form. Your signature confirms the information is accurate. An unsigned form will likely be returned without review.

Documents To Attach

The form instructs you to include any documentation that supports your claim.¹ What helps depends on your reason for disputing:

Services not received: written communication with the provider confirming a canceled appointment, incomplete treatment, or an itemized bill that doesn’t match the work actually done.
Missing refund: an email, letter, or receipt from the provider showing they agreed to issue a refund, along with the date it was promised.
Unauthorized charges: proof that you did not sign an application or authorize the transaction. A police report is especially useful if identity theft is involved.
Deferred interest disclosure issues: the original promotional terms you were given (or evidence that no written terms were provided), plus any marketing materials or sign-up receipts from the provider’s office.

If your insurance covered part of the procedure and the provider charged your CareCredit account for more than your actual out-of-pocket share, include the Explanation of Benefits from your insurer. It shows the allowed amount, what the insurer paid, and what you actually owe, which makes the discrepancy easy to see.

Send copies, never originals. If you have several pages, add a short cover sheet listing what you attached so nothing gets lost in processing.

Where To Mail It and the Ninety-Day Deadline

Mail the completed form and attachments to:

CareCredit
PO Box 628407
Orlando, FL 32862-8407

The form must arrive within ninety days of the date on the notice CareCredit sent you regarding your account.¹ Miss that window and your claim may not be considered. Use a mailing method with tracking or delivery confirmation. Certified mail with a return receipt is the safest option, because that receipt proves when the bank received your paperwork if the deadline is ever questioned.

The form itself lists only the mailing address; no publicly documented online or app-based submission path exists for this specific appeal claim form.

What Happens After You Submit

Once your form arrives, Synchrony Bank opens an investigation. Federal regulations under the Fair Credit Billing Act set the deadlines. The bank must send you a written acknowledgment within thirty days of receiving your notice, unless it resolves the dispute entirely within that same thirty-day period.² From there, the bank has two complete billing cycles, but no more than ninety days, to finish its investigation and either correct the error or explain in writing why it believes the charge is accurate.³

While the investigation is open, you can withhold payment on the disputed amount and any related finance charges. You are still expected to pay the undisputed portion of your balance on time.⁴ The bank also cannot report the disputed amount as delinquent to the credit bureaus during this period.

If the bank rules in your favor, it applies a statement credit to your account and removes any finance charges assessed on the disputed amount.⁴ If it denies your claim, the written explanation must detail why, and the disputed amount becomes due under your normal payment terms.

The Separate Sixty-Day Rule for the Initial Dispute

The appeal claim form and the general right to dispute a billing error operate on different timelines. Under the Fair Credit Billing Act’s implementing regulation, a billing error notice must reach the creditor within sixty days after the creditor sent the first statement containing the error.² That sixty-day clock applies to your initial dispute, the first time you flag the charge with CareCredit or Synchrony Bank.

The appeal claim form’s ninety-day window is separate. It runs from the date CareCredit sends you a notice about your account, typically after an initial dispute decision. If you spot a questionable charge, contact CareCredit promptly to preserve your right to dispute it, then use the appeal form if the initial resolution doesn’t go your way.

Records To Keep After Filing

Make a complete copy of your signed form and every document you attached before sealing the envelope. Store those copies with your mail tracking receipt and the original CareCredit notice that started the ninety-day clock. If the bank claims it never received your paperwork, or the dispute drags past the regulatory deadlines, those records prove you acted on time. Keep them until the dispute is fully resolved and the corrected balance appears on your statement.

1
Synchrony. CareCredit Appeal Claim Form
2
Consumer Financial Protection Bureau. 12 CFR 1026.13 – Billing Error Resolution
3
eCFR. 12 CFR 1026.13
4
Federal Trade Commission. Using Credit Cards and Disputing Charges