Veterans Benefits Clinic Intake Form
Please complete this form PRIOR to calling (434) 817-2189 to pre-register for the clinic. The clinic will be held on Thursday, November 10th from 1-7pm at the University of Virginia School of Law, 580 Massie Rd.
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Do you need handicapped parking?
Branch of service
Your answer
Dates of service
Your answer
Have you filed a claim for disability benefits?
Have you received a decision?
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