Intake form

1. What is your current VA disability rating?

2. Have you been denied a VA disability claim?

3. Are you filing for a new claim, an increase, or an appeal?

4. What do you need help with? (Select all that apply)

5. Do you currently have medical evidence connecting your condition to service?

6. Would you like to schedule a FREE consultation?

7. Preferred method of contact:

disability with? 1.

Name

First

Last

Phone Number

Email