Travel and Appointment Verification Form

Form Description

The Travel and Appointment Verification Form is used to demonstrate the miles traveled to and from medical appointments related to the crime.
There is a special exception which allows for parents or guardians of child victims to claim the miles to and from court related appointments, in addition to medical appointments.

Form Instructions

Please indicate the date, starting and ending addresses, and type of appointment of each trip. Medical appointments will be verified using records from the provider.

On behalf of child victims: If claiming mileage for appointments with law enforcement, Commonwealth Attorneys, Victim Witness, or other criminal justice professionals, please have the professional sign the Travel and Appointment Verification Form.

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