Call Us: 540-464-8700

25 Northridge Lane
Lexington, VA 24450

Forms

RAHC offers many services…..and all under one roof! Our services include medical and dental care for all ages, behavioral healthcare assessments and treatment,  specialty referrals, medication assistance, and patient health education. We offer a sliding fee scale based on household income and family size.

RAHC offers financial assistance through the Sliding Fee Discount Program to those who qualify. Our financial assistance process does not take certain types of income into account,  see the second page of the Application For Sliding Fee Discount Program, or call us at (540) 464-8700, option 4.

RAHC is able to provide services for our insured, uninsured, Medicare and Medicaid patients.  If you have questions about specific insurance plans that RAHC accepts, please do not hesitate to contact us.

Please complete the appropriate forms prior to arriving for your first appointment. For assistance with completing forms, please contact the RAHC Outreach and Enrollment team at (540) 464-8700, option 4.

The forms below are fillable PDFs and may be completed on a computer (you must have Adobe Reader installed). Once completed, print all forms, sign, and hand-deliver  or mail to RAHC at 25 Northridge Lane, Lexington, VA  24450 or FAX to (540) 464-1362.

Please click the links below for the appropriate forms:

En Español:

Ofrecemos ayuda financiera a los quiénes son calificados para la escala móvil. Necesitamos prueba de ingreso de un mes para procesar la aplicación.  Lea la seugnda página del Aplicación de asistencia financiera.