NEW PATIENTS

All are welcome at the Blue Ridge Free Clinic!

  • Don't have insurance and not eligible for Medicaid?  We'll see you.

  • Don't have insurance and eligible for Medicaid?  We'll help you get signed up.

 
 

NEW PATIENT APPLICATION FORM

Complete this brief form and someone from the clinic will get back to you within 2 business days.​

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Thanks for submitting! Someone will be in touch with you soon!

Important!  Before your first visit, please download and print these forms.  Bring the completed forms with you to save time!

Eligibility Criteria

 

(for free pharmacy and ancillary services (labs, X-rays, specialty care) through Sentara RMH Medical Center)) 

Family Size

Annual Income

$40,770

$54,930

$69,090

$83,250