Mental Health Treatment Form
Form Description
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 up to forty sessions of a trauma-informed treatment plan.
Form Instructions
The mental health provider should complete the Mental Health Treatment Form in its entirety.
Fax, mail, or email to:
Virginia Victims Fund
P.O. Box 26927
Richmond, VA 23261
Fax: 804-823-6905
info@virginiavictimsfund.org