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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.
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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.
Important! Before your first visit, please download and print these forms. Bring the completed forms with you to save time!
Intake Form
(English & Spanish)
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
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