FREE CLINIC OF CENTRAL VIRGINIA, INC.
ADMINISTRATIVE FEE STRUCTURE

These fees are used to PARTIALLY "cover" the administrative costs for the delivery of these services.

• $2.00 - Medical Visit - Physician, Nurse Practitioner, Nurse (Lab Work, Flu Shot, Other)

• $2.00 - Prescription - New or Refill - This rate is for EACH 30 day prescription

• $5.00 - Dental Visit - Dentist or Dental Hygienist There will NOT be a charge for the removal of stitches.

• $5.00 - Other Treatments to be determined.

• $5.00 - Referral Visit to Outside Specialty Physician

• "$5.00 Prepaid - Specialty Medical Appointment"

• $5.00 - Eyeglass Fee - Free Clinic Patient"

• $10.00 Prepaid - Specialty Medical Appointment for Referred Patient (i.e. JUC, Veteran's Center, Health Department, Bedford Christian Free Clinic, Etc."

• $10.00 - Eyeglass Fee - Referred Patient (As Above)"

• $10.00 - Prepaid - Dental Specialty Appointment"

• $25.00 - Six Month Fee for MedsHelp Program

NOTE: Only the Program Coordinator and/or the Executive Director (or designee) may approve any exception to these fees or variation in these payments.