Multnomah County Veterans' Services Referral Form
Thank you for filling out this inquiry. Please include as much information as possible. You can expect follow-up contact from Multnomah County Veterans' Services within 3 business days. If you have any additional questions or concerns please feel free to contact us at 503-988-VETS (8387).

Note to case managers and service providers: if you are filling out this form on behalf of a client, you may enter your e-mail address in the first line to receive a copy of the completed form for your record. The client's e-mail address can be added at the end.

Email address *
Veteran's Name *
Your answer
Claimant's Name (if not the veteran i.e. Widow)
Your answer
Claimant's Preferred Method of Contact *
Required
Claimant's Phone Number or Email Address *
Your answer
Briefly explain the purpose for this inquiry (disability, pension, housing, etc.): *
Your answer
Veteran's Branch of Service (select all that apply)
Veteran's Era of Service (select all that apply)
Referring Agency or Individual *
Required
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