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MVAC Intake Form

Fields marked * are required. Everything you type here is encrypted before it is stored, and it is read by MVAC alone, never a call center.

Privacy notice: Submit only your own information or information you are authorized to provide. Intake data is encrypted before storage and reviewed through a protected admin portal.

Please check these before submitting

About you

First name *

Middle name

Last name *

Date of birth *

Place of birth *

Gender *

Race

How to reach you

Phone number *

Email address *

Street address *

Street address line 2

City *

State / province *

Postal code *

County

Your service

Branch of service *

Rank *

Social Security number * Encrypted the moment you press submit. Dashes optional. Rather not type it? Call 706-383-1717 and it gets taken down by phone instead.

VA file number

MOS

Service entry date

Service entry location

Service exit date

Service exit location

Last 3 duty stations

Honorable discharge? *

Yes No

If not honorable, please explain

Were you in combat?

Yes No

Were you ever deployed?

Yes No

Did you retire from the military?

Yes No

Your claim history

Is this the first time filing for VA compensation? *

Yes No

Current percentage If the VA has already given you a rating, put it here. Leave it blank if you do not have one yet.

Who referred you?

I consent to MVAC using this information to review my intake and contact me about benefits assistance. *

Submitted files get a reply within 2 business days, Monday thru Thursday.

Veterans Crisis Line If you are in crisis or having thoughts of suicide, call 988 and press 1, or text 838255. Free and confidential, 24/7. You do not need to be enrolled in VA benefits or health care to reach them.

Military Veterans Assistance Center helping veterans understand benefits, prepare claims, and connect with resources.

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