Patient Referral for VCU Health MLP

Thank you for referring a patient to VCU Health’s Medical-Legal Partnership (MLP). Please review our case acceptance criteria before proceeding. If you are unsure if the patient you are referring qualifies for services, or whether their legal issue is within our scope, please call our program manager at (804) 845-8934 or email us at mlp@vcuhealth.org. For more information about the MLP, please visit our SharePoint site (accessible only to VCU Health employees) or our website.


All patients (or their parent, guardian, or legally authorized representative) must sign a release of information form and program consent form before we can assign their case to an MLP attorney. Forms are available for download on our SharePoint site in English
, Spanish, and Arabic. They must be printed and signed OR signed electronically through DocuSign. If possible, please attach a scan/PDF of completed forms to this referral or send to mlp@vcuhealth.org. Ensure the form is filled out completely, including all four lines of the “Information Requested For” box.


MLP Service Locations


We serve patients from the following clinical and community locations:

  • CHoR Brook Road

  • CHoR Outpatient Pavilion & Inpatient Tower

  • Complex Care Clinic

  • Emergency Department

  • Hayes E. Willis Health Center

  • Massey Cancer Center

  • Ryan White HIV Program

  • Sickle Cell Program

  • Virginia Treatment Center for Children

  • Dominion Place Apartments

  • Health Hub at 25th


Legal Issue


We offer services in the following areas of law:

  • Adult guardianship and conservatorship

  • Consumer

  • Education

  • Employment

  • Estate planning

  • Family

  • Housing

  • Immigration*

  • Public benefits**


*Asylum, Special Immigrant Juvenile Status, and medical deferred action cases only. Immigration status must be a barrier to care. E.g., a patient who needs Medicaid in order to receive a kidney transplant.

**At this time, we are only able to provide assistance in SSDI and SSI cases for patients currently in cancer treatment or in cancer treatment within the past five years.


We are unable to assist with:

  • Criminal law

  • Traffic court

  • Medical malpractice

  • Personal injury or worker's compensation


Service Area


For patients currently in cancer treatment or in cancer treatment within the past five years, we do not have a geographic residency requirement.


All other patients referred to the MLP must live in Central Virginia, defined as:

  • City of Charlottesville

  • City of Richmond

  • City of Colonial Heights

  • City of Petersburg

  • Albemarle County

  • Dinwiddie County

  • Greene County

  • Fluvanna County

  • Louisa County

  • Nelson County

  • Charles City County

  • Prince George County

  • Surry County

  • Chesterfield County

  • Goochland County

  • Hanover County

  • Henrico County

  • New Kent County

  • Powhatan County


Household Income


Household income must be below the current Housing and Urban Development Low-Income Limit for Virginia:


Household size

Annual income limit

1

$63,700

2

$72,800

3

$81,900

4

$90,950

5

$98,250

6

$105,550


Patient Information














Responsible Party



Contact Information





Household Income



Legal Issue





Information about the individual making the referral


Please provide your information below so that the MLP team can follow up with you as needed.




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Release of Information & Client Consent

Contact Information