|How to Apply
Application and Consent Form Packet for Services
Call the main Brain Injury Services of SWVA office to request an application packet (540-344-1200) or toll-free at 1-866-720-1008 or download the application packet form below.
Fill out the application packet completely, sign and date and mail it to:
Brain Injury Services of SWVA
3904 Franklin Road, Suite B
Roanoke, VA 24014
Or fax the completed, signed and dated application packet to (540) 344-9755.
A BIS SWVA employee will contact you for additional information, if required, and to let you know your application packet has been received.
Your application packet will be presented at the monthly meeting of the Intake Review Board (IRB). Please note that in some urgent situations, Case Management Services may begin immediately.
Within one week of the IRB meeting, you will be notified of your status. Decisions rendered by the IRB are:
- Approved — Individuals determined "Accepted" will be assigned a Case Manager immediately.
- Not Approved — Notification of this status is sent if the IRB determines that an individual might be better served elsewhere or does not qualify for services under BIS SWVA eligibility requirements.
- Pending — An individual is placed in this status when the IRB requires more information in order to make its decision.
- Waiting List — Individuals placed on a waiting list will be prioritized, and will receive services as soon as a Case Manager becomes available.
If an applicant has problems with drugs or alcohol, he/she can be denied unless the applicant is currently participating in a substance abuse program and following treatment recommendations.
Eligibility requirements for case management shall be applied without regard to sex, race, creed, and/or national origin. Reasonable accommodations in accordance with the Americans with Disabilities Act (ACT) shall be provided to individuals served.
Download of Application Packet Instructions:
To download the application packet, you must have the Adobe Acrobat Reader installed on your computer. If you do not have the Acrobat Reader, you may download it from the Adobe Reader download page free of charge. Click logo to download program.
Click Here to download BIS SWVA application packet.
If you have additional questions about the application packet process, or need assistance completing the application packet, please contact our office at
540-344-1200 or 1-866-720-1008.
We look forward to working with you!