• Veteran Experience Intake

    Submit your experience with VA healthcare or benefits. This form is anonymous by default and designed to identify patterns for oversight. Please read the consent and privacy notice before proceeding.

  • Purpose, Consent, and Privacy

  • My statement

    Who is behind this. I am a veteran. That is the whole of my authority. I do not work for VA. I have no affiliation with any veterans service organization, no legal training, and no connection to anyone inside the system. Nobody asked me to build this and nobody is funding it.

    I built it because individual complaints go nowhere, and I wanted to find out whether what happened to me is happening to other people at the same facilities. I cannot fix your claim, get you an appointment, or intervene in your care. What I can do is collect enough accounts, carefully enough, that a pattern becomes hard to ignore.

    If you need help with an individual problem, an accredited Veterans Service Officer can actually represent you at no cost. They are listed at va.gov/ogc/apps/accreditation. This form is not a substitute for that.

  • Why this form exists. Individual complaints to VA disappear. Patterns do not. This form collects structured, documented accounts of VA healthcare and benefits failures so that recurring problems can be identified by facility and presented to the VA Office of Inspector General, the VA Office of the Medical Inspector, and the House and Senate Committees on Veterans' Affairs. Each question is tied to a published VA standard, so your answer can be measured against what VA is already required to do.

    What this is not. This is not a legal claim and does not preserve any deadline. If you were harmed by VA medical care, an FTCA claim on Standard Form 95 generally must be filed within two years. Benefits disputes run through the Board of Veterans' Appeals. This form does not create an attorney-client relationship.

    Your privacy. This form is anonymous by default. Do not enter your name, Social Security number, VA file number, or date of birth anywhere except the optional final section. Aggregate results may be published. Individual responses will not be published without separate written permission. Results will never be broken out in groups small enough to identify anyone.

    If you are in crisis, call the Veterans Crisis Line at 988 and press 1.

    Click Here to Dial 988

  • I have read the above and want to submit my experience.*

  • Service Context

  • Facility and Timeframe

  • Know the standard. VA's access standards are 20 days for primary care and mental health care, and 28 days for specialty care. Drive time standards are 30 minutes for primary and mental health care, 60 minutes for specialty care. If VA cannot meet these, you become eligible for community care under 38 U.S.C. 1703(d). Eligibility is not automatic referral. You elect it with your VA provider and choose from providers in VA's network, and VA is required to tell you that you are eligible. Many veterans are never told.
  • Category of Failure (select all that apply)*

  • Specifics

  • What you did about it

  • Did you report this to anyone at VA? (select all that apply)
  • What happened when you reported it? (select all that apply)
  • Do you have documentation? (select all that apply)*

  • Optional Contact

  • Would you be willing to be contacted about your response?
  • Select all you'd consider (if willing to be contacted)

  • Click Here to Dial 988

    If you are in crisis, call the Veterans Crisis Line at 988 and press 1.

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