MCGTN VSO Client Intake

Veterans Services Client Portal

New Client Form

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About Me

First Name: *

Middle Initial: *

Last Name: *

Gender: *

Social Security Number: *

Date of Birth: *

Contact Info

Phone Number: *

Email Address: *

Mailing Address

Number and Street: * Apt/Suite:

City: *

Zip Code: *

County/State: *

Background Information

Mark all that apply: *
I am homeless
I have a Terminal Illness
I am over 85
None of the above

Have you ever filed a claim with the VA?: * If yes, please enter your percentage:

Do you have any pending Appeals and/or an Attorney? *

NOTE: If you have a pending appeal, changing your representative during the appeals process —especially if you have an attorney— can disrupt your case, cause delays, and affect how it is handled. Before signing any forms, please inform the front desk if you have a pending appeal and/or an attorney.

Appointment Details

Appointment type: *

If you selected "other" appointment type, please describe: *

Officer preference: *

Upload DD214 or other
Military Discharge Document:

Upload Additional PDF Documents

Additional Documents: (if applicable)

Examples of documents to upload:

Retirement Orders
Marriage Certificate/SSN for spouse
Birth Certificate/SSN for dependent children (18 & under or 19-23 college)
Medical Records
Doctor's Note
Divorce decrees for previous marriages
Direct deposit information, bank acct, & routing number (Must BE ON EITHER a Voided Check OR Direct Deposit Slip from bank OR SF-1199a completed by financial institution)
Other relevant documents

Next Steps - Remote Signature for VA Intake Forms

Once your request has been reviewed and processed, you will receive an email with two important forms to sign electronically:

VA Form 21-0966 (Intent to File)

VA Form 21-22 - (Appointment of Veterans Service Organization as Claimant's Representative)

These forms will be sent to you via secure email for remote signature. Please note: You will only have 72 hours to sign and return the forms before the link expires. Once you sign and submit the forms, we will call you to schedule your appointment. Please watch your inbox (and spam folder) for the remote signature request. Let us know right away if you need assistance or did not receive the email.