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New Patients: Text

NEW PATIENTS

All are welcome at the Blue Ridge Free Clinic!

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  • 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 Patients: Text
New Patients: Contact

NEW PATIENT APPLICATION FORM

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

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

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

Income Levels to Access Care
(for free pharmacy & ancillary services (labs, X-rays, specialty care) through Sentara RMH Medical Center))
Based on 2025 income levels.  Citizenship is not required for Free Clinic services. 

Family Size

Sentara Free Care
Income Up To 300% FPL:

$21,597

Medicaid Income Up To 138% FPL:

$29,187

$36,777

$44,367

$63,450

$96,450

$79,950

$46,950

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