VHF's Financial Assistance Program

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Download the Financial Assistance Program Application (Word Doc.) »

Download the Financial Assistance Program Application (PDF Fillable Form) »


To improve the quality of life for individuals and/or families with inherited bleeding disorders by providing financial support, based on availability of funding, to help pay for:

Expenses incurred in the care, treatment, or prevention of an inherited bleeding disorder such as, transportation to clinic or hospital, medic alert bracelets, and related expenses are a priority.

Other basic living expenses will be considered on a case by case basis and may include dental expenses, assistance with utility expenses, rent, etc.

Note: Because of the time-line in processing these requests, these funds cannot be considered for most emergency related expenses. Every effort should be made to utilize other community resources such as Social Services, food banks and other organizations that routinely meet these types of needs. This program is intended to help individuals and families after other sources of assistance have been exhausted or unavailable.


Successful applicants will meet the following criteria:

  • A constituent that lives in the territorial jurisdiction of VHF or receives treatment for an inherited bleeding disorder at any of the three area Hemophilia Treatment Centers (HTC’s) (CHKD, VCU, or UVA).
  • Parent or caregiver of an individual living in your home or an individual with a diagnosis of an inherited bleeding disorder, the treatment and care of which is within the mission and purpose of VHF as determined by the Executive Director in consultation with the Executive Board and/or the Financial Assistance Program Committee.
  • Complete all sections of the application thoroughly and accurately in order for VHF to review the request. If a question does not apply, it should be marked not applicable (n/a). Failure to provide complete and truthful information may result in denial of your request.
  • Coordinate request with the Social Worker and/or Nurse Coordinator at a hemophilia treatment center or other healthcare provider treating inherited bleeding disorders.


  • Funding assistance is not guaranteed and is dependent upon availability of funds. Payment of funds upon approval cannot be guaranteed earlier than two weeks, and may take longer, from the date of the request due to committee logistics.
  • Disbursements will be monitored and reported with names omitted to the Board of Directors.
  • Assistance is limited to twice per calendar year unless special circumstances are presented.
  • The assistance amount has been set at $250 per request.
  • The application will be reviewed as an “identity blinded” document by the current “Financial Assistance Program Committee”. However, circumstances may require that the documents may be processed by the chapter Treasurer or President.


All applications and information pertaining to funding requests are considered confidential to the extent permitted by applicable law.

Aggregate data on the Financial Assistance Program Fund will be available, but will not include the names or any identifying information.

Request Process

Download the Financial Assistance Program Application » or get one through your hemophilia treatment center. If you have any questions call 804-740-8643.

  • Requests can be received from the hemophilia treatment center, other healthcare provider treating inherited bleeding disorders and/or directly from the patient/family.
  • To facilitate your request, it is highly recommended, if possible, that you review your application with the social worker and/or nurse coordinator at your hemophilia treatment center. The treatment center can review and forward your application to VHF.
  • Before payment can be issued, a bill must be submitted with the request.
  • All identifying information is removed and the facts of the request are sent to the Financial Assistance Program Committee for review.
  • The decision is communicated to the Executive Director who in turn notifies the appropriate treatment center or person making the request.
  • The Executive Director ensures that the patient/family requesting assistance is not chronically abusing the system.
  • Any request that is approved is generally paid/endorsed directly to the company owed the payment such as phone, utility or mortgage company. Copies of the request, bills and payments will be kept on file.

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