Contact Us

MAILING ADDRESS:

VITO, Inc.
P.O. Box 14188
Norfolk, VA 23518

Phone: 757-965-9234
Fax: 757-965-9769

Required *

Your Name *

Phone

Address

Interested In In-Home Services Day Support Services Employment

If interested in services, please tell us about the individual to be served:

Name

Age

Diagnosis

What Service Are You Interested In?

In-Home
Day Support

Does the individual have a Case Manager? Yes No

Case Managers Name

Does the individual have a Medicaid Waiver “Slot” Yes No

If no, is there another agency responsible for funding? Please explain:

Is the individual currently being served by another agency? Yes No

Name of Guardian (if self, please put SELF):

Additional Information/Comments: