• Connecting you to trusted resources, support, and opportunities.

    Connecting you to trusted resources, support, and opportunities.

  • Complete the Veteran Passport to tell us about your needs and the support you're looking for.

    Veterans Collaborative will use the information you provide only to help connect you with trusted local, regional, and national resources through the VC RADAR Resource Network.

    We invite you to participate in the optional Heads Up Vet Brain Health Check-In, designed to help you identify potential connections to undiagnosed head injury from subconcussive and repetitive blasts when appropriate.

    Most people complete the initial form in just a few minutes. Participation is voluntary, and you decide what information you choose to share.

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  • Format: (000) 000-0000.
  • Military Affiliation
  • Are you a Post 9/11 service member, veteran, or family member?
  • Gender
  • Age
  • Do you have a DD214?
  • Do you have a Disability Rating?
  • Are you currently enrolled with the Veterans Administration (VA)?
  • Initial Needs Request
  • Would you like to learn information and complete a self check-in for Head Injury related to sub-concussive and repetitive blast exposure?*

  • Heads Up Vet Brain Health Check-In (Optional)

  • Understanding Repetitive Blast Exposure

    Your brain health matters. This brief series of six questions is designed to help you build awareness and connection to military service head injuries, blast exposure, or other experiences that may affect brain health and overall well-being.

    You will receive a copy of your responses to begin discussions with your care team. This is not a medical diagnosis or clinical evaluation.

    To learn more about Heads Up Vet visit: https://www.veteranscollaborative.org/headsupvet

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  • I understand and wish to continue:*

  • We’re helping people recognize over lapping experiences that may be a result from undiagnosed head injury. Experiences may be surface years after direct, sub-concussive, or repetitive blast exposure. 

  • Have you experienced any of the following during service, training, athletics, or operational environments?
  • Experiences may include:
  • Have you been assessed for concussion, TBI, or head injury before?
  • Do you request wrap around services, support, and/or case management for head injury?
  • Have you learned something about direct, sub-concussive, or repetitive blast exposure today?

  • Acknowledgment and Consent

  • How do you prefer Veterans Collaborative connect you with our RADAR resources?

  • Please share any additional information you feel helpful, as we review your in-take. 

  • Please note: The Veteran Passport Resource In-take form is not a crisis-response or daignostic tool with immediate response times.

    If you are experiencing a mental health emergency or would like to speak to a mental health professional, call 911 or the Veterans Crisis Line at 1-800-273-8255 and press 1, chat online, or text 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year.

    By submitting this form, you authorize Veterans Collaborative to use the information you provide to connect you with trusted resources, coalition partners, and support services you request. We do not sell your information.

    Please review our Privacy Policy and Terms of Use, and I consent to services.

     

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