HOW TO APPLY

application

Access to services starts with our Application Packet. The client or family completes the needed forms and returns them to BISSWVA either online, by mail, or fax.

ONLINE

Download the complete application packet, fill it out, and email it to info@bisswva.org

Application

All forms are PDF files. You will need AdobeReader® to view them.
Use the link to below to download AdobeReader® if you do not already have installed on your computer.

Adobe PDF Reader

by mail

Call our office to request the application packet be sent to you via mail at:
540-344-1200
or toll-free at
866-720-1008.

Fill out and mail back the completed application packet to:

Brain Injury Services of SWVA

3904 Franklin Rd., Suite B Roanoke, VA 24014

fax

You can also FAX the completed application packet to 540-344-9755.

IMPORTANT TO KNOW

note

If an applicant struggles with drugs or alcohol, or severe mental health issues, he/she can be denied unless currently participating in an appropriate treatment program.

NONDISCRIMINATION POLICY

Eligibility for case management shall be applied without regard to sex, race, creed, and /or national origin. Reasonable accommodations shall be provided to individuals served, in accordance with the Americans with Disabilities Act (ADA).

fees

BISSWVA is a nonprofit funded by the Commonwealth of Virginia and with private donations. There is no charge for Case Management services.