Welcome to the Wisconsin Association of Free and Charitable Clinics (WAFCC) and Volunteer Healthcare Provider (VHCP) Program Applications
Below you will find two applications. Please select the application appropriate for your organization. It will take you anywhere from 40-60 mins to complete. Please read carefully to ensure your correct enrollment.
1. Free and Charitable Clinic (FCC) Application
(WAFCC Membership and/or VHCP Enrollment)
All FCCs must submit this application to become a member of WAFCC and/or to enroll for VHCP coverage. This application allows your clinic the opportunity to join both or op-out of one.
If you wish to review the application before submitting it online at the link above, click here to download the pdf. version. You may also mail your paper application to 1256 Capitol Drive Suite 700 #210, Pewaukee, WI 53072
If you wish to review the application before submitting it online at the link above, click here to download the pdf. version. You may also mail your paper application to 1256 Capitol Drive Suite 700 #210, Pewaukee, WI 53072
2. Non FCC Organization Application
(VHCP Enrollment Only)
All Non FCCs must submit this application to enroll for VHCP coverage. Please do not use this application to enroll for coverage if your organization is a FCC (instead use application #1 above).
If you wish to review the application before submitting it online at the link above, click here to download the pdf. version. You may also mail your paper application to the address listed above.
If you wish to review the application before submitting it online at the link above, click here to download the pdf. version. You may also mail your paper application to the address listed above.
Questions, Comments, Concerns?
Contact WAFCC's Executive Assistant at Heather.Ule@wafcclinics.org or 440-781-3513 for all inquiries.