New Patients: Text

NEW PATIENTS

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.

To make a medical, dental, or mental health appointment - the process is the same:

1) Call 540-705-0337

OR

2) Request an appointment with the form below.

A volunteer will contact you within 2 business days to setup an eligibility intake visit.

This is required for ALL new patients.

(Patients must show proof of household income to be scheduled for any services)

Income Levels to Access Free Clinic Care
(including pharmacy, dental, and ancillary services (labs, X-rays, & specialty care from Sentara RMH)

Family Size

Medicaid
(income up to 138% FPL)

1

2

3

4 $22,024

$29,863

$37,701

$45,504

Sentara Free Care
(income up to 300% FPL)

$64,920

$47,880

$81,960

$99,000

Based on 2026 income levels. Citizenship is not required for Free Clinic services.
*FPL = Federal poverty line

New Patients: Text

New Patients: Contact

NEW PATIENT APPLICATION FORM

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

Registration Intake

Release of Information

Financial Form

NEW PATIENTS

​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.

​

​​

To make a medical, dental, or mental health appointment - the process is the same:

1) Call 540-705-0337​

OR

2) Request an appointment with the form below.

​

A volunteer will contact you within 2 business days to setup an eligibility intake visit.

This is required for ALL new patients.

(Patients must show proof of household income to be scheduled for any services)​

​

Income Levels to Access Free Clinic Care (including pharmacy, dental, and ancillary services (labs, X-rays, & specialty care from Sentara RMH)

Family Size

Medicaid (income up to 138% FPL)

1

2

3

4

$22,024

$29,863

$37,701

$45,504

Sentara Free Care (income up to 300% FPL)

$64,920

$47,880

$81,960

$99,000

Based on 2026 income levels. Citizenship is not required for Free Clinic services. *FPL = Federal poverty line

NEW PATIENT APPLICATION FORM

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

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

1) Call 540-705-0337

(Patients must show proof of household income to be scheduled for any services)

Income Levels to Access Free Clinic Care
(including pharmacy, dental, and ancillary services (labs, X-rays, & specialty care from Sentara RMH)

Medicaid
(income up to 138% FPL)

Sentara Free Care
(income up to 300% FPL)

Based on 2026 income levels. Citizenship is not required for Free Clinic services.
*FPL = Federal poverty line