Call Us: 540-464-8700

25 Northridge Lane
Lexington, VA 24450

Forms

RAHC offers many services…..and all under one roof. Our services include primary medical, dental (at 2 locations) and behavioral health care for all ages, Women’s Health,  specialty referrals, medication assistance, and patient health education.  We accept most forms of insurance, and we also provide services to the uninsured.  Additionally, we are a Veteran’s Choice Provider.

We offer additional savings on services to insured and uninsured patients through our Sliding Fee Discount Program, which is based on tax household income and family size. The second page of the Application For Sliding Fee Discount Program provides instructions on how we calculate household size and income.  Missing/incomplete paperwork will delay the process. For questions on the Sliding Fee Discount Program, please call (540) 464-8700, option 1.

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.  Staff are available for anyone needing assistance completing the forms.

Please click the links below for the appropriate forms:

 

En Español: