Rock River Community Clinic Volunteer Form

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As a community health centers, Rock River Community Clinic (RRCC) provides comprehensive and cost-effective health care services for residents in Jefferson, Dodge, and Walworth County. RRCC was formed in January 2020, merging the former Community Dental Clinic (Fort Atkinson), the Rock River Free Clinic (Jefferson), and the Watertown Area Cares Clinic and adding a new medical clinic site in Whitewater.

At RRCC, all community members are welcome and accepted, regardless of ability to pay, with discounted prices for patients who are uninsured or underinsured (high deductible plans). RRCC also provides care coordination services to help patients overcome barriers to accessing healthcare (e.g., transportation), and care referrals. By increasing access to health care services, offering care at affordable costs, and assisting with healthcare navigation, RRCC works to create a healthier, more equitable, community.

For clinic hours and locations, visit www.rockrivercommunityclinic.org

Full Name (First & Last)

Phone Number

Age

Language(s) Spoken

English

Spanish

Other:

Have you volunteered with RRCC previously? (As RRCC or WACC, RRFC, or CDC)

Yes

Clear selection

Do you have any experience working or volunteering in a healthcare setting outside of RRCC?

Yes

Clear selection

If yes, what did your prior (or current) experience entail?

Volunteer Interests

Marketing & Promotion

Dental Support and Assistance

Medical Support and Assistance

Translation Support (English/Spanish)

Fundraisers and Event Support

Cleaning and Facilities Support

Open to any and all tasks!

Other:

If you have specific skills, interests, or abilities that you think would help RRCC, please include them here:

What days and times work best for you to volunteer? (select all that apply)

Morning

Afternoon

Evening

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What locations would you be most able and interested to volunteer at? Select all that apply

Whitewater (1461 W Main Street) -- Medical Clinic

Fort Atkinson (520 Handeyside Lane) -- Dental Clinic

Watertown (415 S 8th Street) -- Medical Clinic

Jefferson (1541 Annex Road) -- Medical Clinic

Thank you so much for completing this Volunteer Interest Form. As we work towards new initiatives, we'll reach out with more information!

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