• Veterans Legal Services Information Form

    Please complete and submit this brief form to be screened for a connection with one of our referral attorneys.

  • STOP 22 is not a law firm. Legal services are not provided by STOP 22. STOP 22 connects Veterans with attorneys within our referral network.

    Referral requests currently accepted for: Expungements, Discharge Upgrades, Minor Traffic Violations, and Business Formation.
  • Today's date
     - -
    2 digit month, 2 digit day, 4 digit year

  • A.  IDENTIFICATION

  • Format: (000) 000-0000.
  • May we send you a message?*
  • May we leave a message?*
  • May we send a text?*
  • May we leave a message?*

  • B. MILITARY SERVICE

    *** NEED NOT BE HONONRABLY DISCHARGED TO ATTEND CLINIC ***
  • Which Branch(es) of Service did you serve?
    Rows
  • If you have received an "Other-than-Honorable" discharge designation, would you be interested in being contacted to learn more about discharge upgrades?

  • C.  Health & Mental Health Information

    *** This Section is COMPLETELY VOLUNTARY and NOT REQUIRED *** Information provided will be used to assist STOP 22's mission of reducing veteran suicide. All information provided is private, confidential and not shared with any third-parties.

  • IF YOU ARE IN CRISIS NOW

    PLEASE CALL the VETERANS CRISIS LINE at 800-273-8255 or TEXT 838255 National Suicide Prevention Lifeline by dialing 988 or 800-273-8255
  • How would you rate your current physical health?
  • How would you rate your current sleeping habits?
  • Do you have adequate access to food?
  • Are you currently experiencing overwhelming sadness, grief, or depression?
  • Are you currently experiencing anxiety, panic attacks, or have any phobias?
  • Are you currently experiencing chronic pain?
  • Do you drink more than once per week?
  • How often do you engage in recreational drug use?

  • ***DISCLOSURES***

    Completing this information form does not create an attorney-client relationship and it does not mean you will receive services from STOP 22. 

    You must have a phone number and email address that is safe for you to receive communications from STOP 22. 

    After sumbitting this online information form, you will recieve a follow-up email or text from STOP 22 to collect additional confidential information about you referral request. 

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