To become a new patient at Chesapeake Care Clinic & Hampton Roads Dental Center, you need to attend an eligibility appointment. Please visit the clinic to pick up the registration forms and schedule an appointment.

Eligibility Requirements for medical services

  • Resident of the City of Chesapeake
  • Uninsured
  • Income Requirement (see table below)

Eligibility Requirements for dental services

  • Resident of Hampton Roads
  • Income Requirement (see table below)

You will need to bring the items listed below to your eligibility appointment. You will be rescheduled if you fail to bring required documents. Please note there is a $20 (cash) processing fee.

  1. Photo ID
  2. Social Security Card
  3. Proof of address (utility/cell phone bill)
  4. Federal Tax Return – if you file or someone else claims you
  5. Food stamp verification letter from social services if you receive (for assistance call social services at 382-2000)
  6. Proof of income (see examples on right) for patient and spouse (if unemployed bring letter of support from person providing food and shelter stating the monthly value plus if you are claimed on their federal tax return Verification of Support Letter
  7. $20 cash

Income Requirement Table

Family SizeYearly Income
123,540
231,860
340,180
448,500
556,820
665,140
773,460
881,780
For each additional person, add8,320

Examples of income documentation

Salary/wages: One month consecutive pay stubs; letter on company letterhead
Food Stamp: Benefit statement; print out from Social Services
Self-employment income: 1099 form including Schedule C along with 1040 form and 3 months of personal and business bank statements
Social Security Retirement: Benefit statement for current year;
Supplemental Security Income: Benefit statement for current year
Social Security Disability: Benefit statement for current year
Veterans Benefits: Benefit statement for current year
Pension/Retirement: Benefit statement for current year or copy of most recent check or check stub
Unemployment: Unemployment award letter on company letterhead indicating amount and time period covered: or copy of most recent unemployment check or unemployment check stub
Alimony/Child support: Court award letter indicating amount and time period covered; or Child Support Enforcement Agency letter; or letter from attorney stating amount and time period covered; or
copy of one month's check
Rental income: Copy of rent check; or copy of lease
Workers Compensation: Award letter or benefits statement indicating amount and time period covered; or one month's check or check stub
Other: Benefits statement; or award letter; or copy of check(s); or judgment statement