Get Prescott Va Dom

Filling out the Prescott Va Dom application online can be straightforward when you have clear guidance. This document provides detailed steps to assist users in successfully completing the application for the Northern Arizona VA Health Care System's Domiciliary Residential Rehabilitation Treatment Program.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the veteran's name, social security number, address, and date of birth in the designated fields. Ensure that the information is accurate and matches official documents.
3. Select the correct gender and marital status by checking the applicable boxes. This section is crucial for demographic purposes.
4. Provide a contact phone number if applicable, selecting 'Yes' or 'No' as appropriate.
5. In the military history section, check the box that corresponds to the longest period of service and provide details of the branch of service, dates of entry and discharge, and type of discharge.
6. Complete the psychiatric/mental health evaluation questions accurately, indicating any hospitalizations and current treatments. Use 'Yes' or 'No' responses for clarity.
7. In the substance abuse history section, answer all questions truthfully regarding alcohol and drug dependency. Specify any past treatment experiences.
8. Address legal history questions, including past charges and current situations, ensuring each box is filled as required.
9. Complete the employment status/income/housing questions, indicating your current situation. Include information about homelessness or financial support received.
10. Fill in the medical information part, answering questions about serious medical problems, medications, and any physical limitations.
11. Review all information for accuracy and completeness. If needed, make amendments to ensure everything is correct.
12. Once you have filled out all sections, save your changes. You can then download, print, or share the completed form as needed.

Complete your Prescott Va Dom application online today to take the first step towards receiving support and services.