top of page

"Empowering Veterans with Expert Guidance and Support for a Successful Transition."

HOME
ABOUT
OUR SERVICES
BOOK ONLINE
BLOG
F.A.Q.'s
GET IN TOUCH
More

Use tab to navigate through the menu items.

Client Intake Form

First Name

Last Name

Email

Phone

Birthday

Did you deploy?

Yes

No

Did you serve under a another name?

Yes

No

List the other name(s) you served under

Did you receive separation pay?

Yes

No

Please list your Entry date

Please list your ETS date

The duty station you ETS from?

Which Branch of Service:

What component of service?

Active

Reserves

National Guard

What is your complete mailing address or PO Box (city, state, zip)

Give a list of claims that you would like to submit.

Thanks for submitting!

Please upload current rating documents and or denials

Upload File

Upload supported file (Max 15MB)

Please upload any medical records applicable

Upload File

Upload supported file (Max 15MB)

© 2025 by The Resilient Vet

bottom of page