Mental Health Treatment Report

The Mental Health Treatment Form is used by counselors or psychiatrists to verify the care they are providing is related to the crime incident. Once completed, this form will allow for payment of the first ten sessions of a trauma-informed treatment plan.

Form Instructions: 

The mental health provider should complete the Mental Health Treatment Report in its entirety.

Fax or mail to:
Virginia Victims Fund
P.O. Box 26927
Richmond, VA 23261
Fax: 804-823-6905