Check to see whether or not you may be eligible to be a Lackey Clinic Patient!

Name *

First Name Middle Name Last Name Suffix

Phone Number *

Please enter a valid phone number.

Date of Birth *

Only Applicants 18 years or older are eligible.

What area do you live in? *

Unfortunately, we are only able to serve patients within our service area which includes Newport News, York County, Poquoson, and Williamsburg/James City County. If you live outside of this area, you are not eligible to be a patient.

Do you have medical insurance? This includes private insurance, Medicaid, Medicare, Tricare, and Veterans Benefits. *

Yes No

Unfortunately, we are only able to serve uninsured adults who do not have any form of medical insurance/benefits. If you currently have Medicare (are over 65) and are in need of dental care please call our Eligibility Department at 757-886-0608 ext. 253 to see if you are eligible.

You may be eligible to be a Lackey Clinic patient!
Click below for our online patient application.