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R-VCHC Online Appointment Interest Form--
The Rowan-Virtua Community Health Center is a patient-focused, free clinic funded entirely by student efforts and donations. It is staffed by physicians in the Rowan-Virtua SOM family, as well as medical student volunteers. The clinic’s main goal is to ensure accessibility to high quality health care in underserved areas and promote healthy living.
Please fill out the following form and we will contact you to make an appointment:
First Name
Last Name
Date of Birth
Legal Sex
Female
Male
Prefer not to answer
Email Address (if you would like to receive an appointment confirmation)
Phone Number (needed to confirm appointment, including date/time)
Mailing Address
Reason for Visit
Physical
Sick/new concern
Follow up
Do you require a Spanish interpreter?
Yes
No
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