Application for Services
STEP 1
Call the main Brain Injury Services of SWVA office to request an application (540-344-1200) or toll-free at 1-866-720-1008 or download the application form below.
Fill out the application completely, sign and date and mail it to:
Brain Injury Services of SWVA
302 2nd Street, Third Floor
Roanoke, VA 24011
Or FAX the completed, signed and dated application to (540) 344-9755
STEP 2
A BIS SWVA employee will contact you for additional information, if required, and to let you know your application has been received.
STEP 3
Your application will be presented at the monthly meeting of the Intake Review Board (IRB). Please note that in some urgent situations, Case Management Services may begin immediately.
STEP 4
Within one week of the IRB meeting, you will be notified of your status.
Decisions rendered by the IRB are:
- Accepted — Individuals determined "Accepted" will be assigned a Case Manager immediately.
- Not Accepted — Notification of this status is sent if the IRB determines that an individual might be better served elsewhere or does not qualify for services under BIS SWVA eligibility requirements.
- Pending — An individual is placed in this status when the IRB requires more information in order to make its decision.
- Waiting List — Individuals placed on a waiting list will be prioritized, and will receive services as soon as a Case Manager becomes available.
Non-Discrimination Policy:
Eligibility requirements for case management shall be applied without regard to sex, race, creed, and/or national origin. Reasonable accommodations in accordance with the Americans with Disabilities Act (ACT) shall be provided to individuals served.
Download of Application Instructions:
To download the application, you must have the Adobe Acrobat Reader installed on your computer. If you do not have the Acrobat Reader, you may download it from the Adobe Reader download page free of charge. Click logo to download program.
CLICK HERE to download BIS SWVA application.
If you have additional questions about the application process, or need assistance completing the application, please contact our office at:
(540) 344-1200 or 1-866-720-1008
Click here to see upcoming events. 