Electronic forms
Provider Referral
Acquaintance Referral
QOL Item(s) Request
Equipment Request
Service Payment Request
Resource Consultation
Please note that Virginia residents who are currently on the waitlist for DD Waiver coverage will be prioritized. All requests will be reviewed by our board of directors for approval and those without priority status will be filled in sequential order. Resource availability is based on currents funds availability.
*Please be patient, we are still working to create these forms and look forward to serving our community soon
It's our responsibility, as humans, to take care of each other
Caitlin Crosby
