Western Tidewater Free Clinic

Uninsured and need healthcare?

Western Tidewater Free Clinic may be able to help you!

To be a patient at WTFC you must:

1. Live in Suffolk, Franklin or Isle of Wight, Southampton, Surry or Sussex counties
2. Have no health or dental insurance
3. Be age 18 or older
4. Have a household income at or below:
   • 1 Person in Household
     • Hourly Income: $18.58
     • Monthly Income: $3,220
     • Annual Income: $38,640
   • 2 People in Household
     • Hourly Income: $25.13
     • Monthly Income: $4,355
     • Annual Income: $52,260
   • 3 People in Household
     • Hourly Income: $31.67
     • Monthly Income: $5,490
     • Annual Income: $65,880
   • 4 People in Household
     • Hourly Income: $38.22
     • Monthly Income: $6,625
     • Annual Income: $79,500
   • Add for Each Additional Person:
     • Hourly Income: $6.55 per hour
     • Monthly Income: $1,135 per month
     • Annual Income: $13,620 per year

Items provided by patient include:

1. PHOTO ID
2. PROOF OF RESIDENCY - Current bill or other 1" class mail dated within the past 2 months - personal mail is NOT accepted
3. PROOF OF INCOME - Income must be provided for all persons listed on combined tax returns and/or
   contributing to household. Minimum = 1 of the following:
   1. IRS Form 1040 Tax Return - PREFERRED
   2. One month of current consecutive pay stubs or cash log (if currently employed)
   3. 1099 Form from the previous year if self employed
   4. Disability Award Letter/Social Security Letter/Pension Award Letter/Retirement Award Letter
   5. Unemployment Letter (if you are receiving unemployment)
4. OTHER, IF APPLICABLE: Virginia Medicaid Denial Letter

Please Call for An Appointment:
(757) 923-1060 ext. 7004

Thank You!