VETERANS APPLICATION -

The Aid & Attendance

After completing your registration, a free phone consultation will be scheduled with our Veteran Benefits Administrator (Fellow Veteran) to discuss the Aid & Attendance Benefits available to you.
We will review the Application Process, Eligibility Requirements and answer any questions regarding your long term health care needs.

Registrant Name:

Email Address

Phone

Applicant Name:

Zip Code of Applicant Residence

Applicant is:

Has The Applicant Ever Served on Active Duty ( At least 90 days) ?

Yes No

Is the Applicant 65 or Older, Blind and/or Totally Disabled? (For Spouse, Click "N/A"

Yes No n/a

Will the Applicant Require Assistance with Daily Living Activities within the next 3 Months?

Yes No

Will the Applicant need Assistance in Completing the Application Process?

Yes No