VETERAN TRIAGE FORM

Are you a veteran or veteran family member who requires support with Department of Veterans Affairs Wellbeing and/or Compensation Entitlements?

A Veteran is a person who is serving or has served in the Australian Defence Force for one day or more.

If you need assistance, please complete the following Triage Form. This form will go directly to our Wellbeing and Compensation Advocacy Team, who will then review your information and get in touch with you (usually within 7 days). This information helps our Wellbeing and Compensation Advocates to prepare to provide you with the best possible support.

Contact Details

First Name *

Middle Name

Last Name *

Date of Birth *

Email Address *

Confirm your Email Address *

Mobile Phone Number *

Home Phone Number

Unit Number or Street Number *

Street Name *

Address Line 2

City or Town *

State/Territory *

Post Code *

Country

Gender

Service Details

PMKeys or Service Number

Service

Other

Service Category

Enlistment Date *

Discharge Date.Current Date if still serving *

Mode of Discharge

Deployment / Operations details (if any)

If you have a DVA Card, what is your DVA File Number?

YOUR WELLBEING STATUS

Are you OK? *

How safe are you? *

How good is your housing? *

Do you have someone to rely on? *

Are you employed? *

Does your income cover expenses? *

How is your health? *

Please briefly indicate the services you require in the following text box

Save and Complete Later