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.

Thank you!

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