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Veteran Intake Form

Is this a permanent or temporary address?
Gender
Is this a new address?
Are you currently homeless or at risk for being homeless?

Current mailing address

Have you ever filed a claim with the VA
Did you serve under another name?
Component Required
Branch of service Required

Additional Periods of service

Most recent active service dates

Have you served in a combat zone since 9/11/2001?
Are you currently serving or have you ever served in the Reserves or National Guard?
Component Required

Obligation terms of service:

Are you currently receiving inactive duty training pay?
Do you know the breakdown percentages of approved disabilities?
Do you have any pending claims?
Are you currently working with another organization?
Do you know the date of your treatment?

Enter the disability treated and the name/location of the treatment facility

Do you know the date of your treatment?
Do you know the date of your treatment?
Are you currently activated on federal orders within the National Guard or Reserves?

If Yes, answer the next questions in the box if No, skip this boxes questions

If Yes, answer the next question in the box.

Have you ever been a prisoner of war?

Dates of confinement:

Retired status Required
Have you ever received separation pay, disability severance pay, or any other lump sum payment from your branch of service?

If Yes, answer the next questions in the box 

Branch of service
Are you receiving military retired pay?

If Yes, answer the next questions in the box 

Will you receive military retired pay in the future?
Branch of service

Direct Deposit Information

Baymon Consulting, LLC

Eugene Baymon, Consultant

Natasha Baymon, Operations Manager   

Email: info@baymonconsulting.com                 

Office phone: 832-482-0043

Office address:

5213 Feagan St., unit F

Houston, TX 77007​

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@2023 Baymon Consulting, LLC

 

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Eugene's Lt. Colonel Merit.jpg
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