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Attorney Forms

ADR Mediator Evaluation Form
Amputation Chart
Attending Physician's Report (Form 6)
Award Agreement
Certificate of Service
Change In Condition Claims Response Form
Claim Form
COLA Request Form (CA51)
Employer's Application for Hearing (Form 5A)
Expedited Hearing Request Form
Fatal Award Agreement
Mediation Consent Form A - All Parties Have Legal Counsel
Mediation Consent Form B - All Parties Do Not Have Legal Counsel
Medical Care Provider Application Response Form
Petition for Medical Treatment
Petition Under Virginia Birth-Related Neurological Injury Act (Form BR1)
Pneumoconiosis Claim Form
Pre Mediation Statement Form (Awarded Claim)
Pre-Mediation Statement Form (All Claims)
Pre-Mediation Statement Form (Contested Original Claim)
Request for Full and Final Mediation
Request for Issue Mediation
Sample Affidavit
Sample Informational Letter
Sample Order
Subpoena Duces Tecum - Attorney Issued
Supplemental Agreement Form Varying Wage Benefits
Termination of Wage Loss Award Form
Wage Chart (Form 7A)
WebFile Attorney Registration Form
Witness Subpoena - Attorney Issued

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