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  • Initial Intake Questionnaire

    This intake form is designed to gather basic information about you and your family to ensure that we provide appropriate support services. All information is confidential and used solely to assist in meeting your needs.
    • Section 1: Veteran Information 
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    • Section 2: Safety and Crisis Concerns 

    • Immediate Assistance Resources

       
      If you or someone you know is in immediate danger or experiencing a crisis, please reach out to the following resources:

      •National Suicide Prevention Lifeline: Call or text 988 (Available 24/7)

      •Veterans Crisis Line: Call 988, then press 1 or text 838255 (Available 24/7)

      •Domestic Violence Hotline: Call 1-800-799-SAFE (7233)

      •Emergency Services: Dial 911

       
      Your safety is important to us. If you answer “Yes” to any safety-related question, a member of our team will follow up promptly to assist you.

    • Section 3: Housing Situation 
    • Section 4: Employment & Income 
    • Section 5: Additional Information 
    • Consent & Signature 

    • By signing below, I affirm that the information provided is accurate to the best of my knowledge. I consent to the use of this information by the Salute to Home Foundation to provide appropriate services.

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