Assistance Request Form

Assistance Request Form
Welcome to the DD-214 Project

This program is reserved for soldiers with a DD-214 who need help accessing the VA Healthcare system.
What do you need help with?*

Computer ProblemsCreating an "ID.me" accountOther login issuesType option 4Other
Additional information (Optional)
Best method to contact you?*
Time Zone
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Verification of status

VA ID Card (or) DD-214 (or) VA verification letter
File Upload

Cancelof
Take Photo
(Documents are only required on your 1st visit) - Please verify that you are human *
Should be Empty:

Verification of status