Request an appointment

To qualify for care at the Free Clinic you must have some income, so we ask some questions about income, family size, and age. Everyone has access to one appointment regardless of your income. Please fill out this form so we can work to provide you with health care!

If you are only in need of STD/STI, vaccines, and/or family planning, please contact the Charlottesville/Albemarle Health Department at (434) 972-6269.

Request an appointment

  • Please enter a number from 1 to 8.
  • Write your monthly or yearly income