VA Disability Compensation & Pension Exam Appointment Request

VA Disability Compensation & Pension Exam Appointment Request
Use this form to request and schedule your VA C&P exam appointment. Please provide accurate information to help us process your request efficiently.
Applicant Full Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Contact Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Branch of Military Service
Period of Service (Years)
VA File or Claim Number (if known)
Briefly describe the disability claim(s) for which you are requesting an exam
Preferred Appointment Date and Time
Do you have any special accessibility needs for your appointment?
Should be Empty: