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Veterans Information Form

Veteran Information
Indicates a required field.
  1. Which of the following statements is most accurate?
  2. Which of the following military components do you currently serve in (or most recently served in)?
  3. Are you currently the spouse of a service member?
  4. Which of the following military components does your spouse currently serve in?
  5. Are you currently married or in a committed relationship that has lasted at least one year?
  6. Are you currently a Tricare beneficiary?
  7. Have you ever had thoughts about suicide or deliberately injured yourself in any way?
  8. Are you interested in receiving treatment for posttraumatic stress disorder (PTSD)?
  9. Are you currently using opioid medications (e.g., hydrocodone, morphine, Vicodin, Lortab, methadone, tramadol, and others) to manage chronic pain?
Last Updated: 6/7/17