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Connect With VetPhoenix Programs and Services

Complete this secure intake form to connect with VetPhoenix’s peer-led programs, housing support, and justice-system navigation services designed to help veterans rebuild stability, purpose, and community.

Participant Information

Date of Birth:
Month
Day
Year

Military Service Information

Branch of Service:
VA Status (check one):

Justice-Involvement

Current Status:

Residence History

Health & Behavioral Health

Substance Use Support Needed:
Yes
No

Risk & Safety

Any current restraining orders?
Yes
No

Support Systems

Program Needs

(Check all that apply)
Housing
Clinical therapy
Peer mentorship
VA claims support
Employment assistance
Transportation
Life skills / financial literacy
In-prison programming continuation

You're not alone.
We're here to help.

If you’re a justice-involved Veteran ready to take the next step toward support and resources, reach out today.

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