EligibilityCan We Help You
You may be eligible for medical care at the Free Clinic of Culpeper if you:
- Are uninsured
- Are over the age of 18
- Live in Culpeper
- Have an annual income below 250% of the federal poverty level (please see the chart below).
Those applying for care must provide copies of the most recent tax returns for all family members. Family is defined as persons living together in a household who have a legal responsibility to each other.
To apply for services you must fill out a patient application and provide copies of all needed certifications. Clinic staff will help you with this process. Once we have received and reviewed all your application materials you will be contacted to schedule your first appointment.
You can print out the forms below and bring them to the Free Clinic for eligibility screening.