Veteran Intake Form — GMAC CRM 2.0

Personal Information

Enter the veteran's legal name and date of birth.

First Name

Required

MI (opt)

Last Name

Required

Date of Birth (opt)

Identification

Social Security Number is required for VA form processing.

Your SSN is encrypted and stored securely. It is only used to fill VA forms.

Social Security Number (opt)

— —

Please enter a valid 9-digit SSN

Contact Information

Email and phone used for VA correspondence.

Email Address

Enter a valid email address

Phone Number (opt)

— —

US numbers only (area code + 7 digits)

Enter a complete 10-digit phone number or leave blank

Mailing Address

Must match the address on file with the VA.

Street Address (opt)

Apt / Unit (opt)

City (opt)

State (opt)

ZIP Code (opt)

Enter 5-digit ZIP

ZIP+4 (opt)

Country

Meeting History Optional

Log any meetings held with this veteran. You can skip this section and add meetings later.

💡 Add as many meetings as needed — each entry is saved to the client's profile.

Add a Meeting

Meeting Date

Start Time (opt)

End Time (opt)

This meeting was transcribed

Notes (opt)

Filed Forms & Conditions Optional

Record VA forms already filed and the veteran's claimed conditions.

Filed Forms

Add a Filed Form

Form Name / Description

VA Form Key (opt)

Claimed Conditions

Current VA Disabilities & Percentages

Conditions Intended to File

Pending Action Items Optional

Add tasks for staff and/or the veteran to complete.

Staff Actions

Add Staff Action

Task Description

Due Date (opt)

Client Actions

Add Client Action

Task Description

Due Date (opt)

Review & Submit

Confirm all information before submitting.

Intake Complete