top of page

VA WELLNESS SUPPORT

At IC&C, we understand that navigating benefits can be overwhelming. Our goal is to empower veterans and their families through education, resource sharing, and peer-to-peer support. We help members confidently explore the benefits and services they may be eligible for.

Your Trusted Partner

Keeping You Connected

multi-generation-family-welcoming-army-father-home-on-leave-with-banner.jpg

This form is designed to help us better understand your needs and connect you with appropriate resources and qualified professionals.

​

All information shared on this form will remain confidential and used solely for referral, educational, or coordination purposes. Your personal data will never be shared without your written consent.

Are you a Veteran or an Active Duty Member?
Yes
No
Did you receive any injury during your time in service?
Yes
No
I'm not sure.
Are you currently working with Veterans Service Organizations?
Yes
No
I'm not sure.
Are you looking to get your Disability Rating Increased?
Yes
No
Do you understand that we offer an Online Support Resource Hub providing connections to medical & resource providers? We do not Process VA Claims.
Yes
No
What is your current military status?
Have you ever worked as a federal contractor OUTSIDE of the United States?
Yes
No
Were you injured while working as a federal contractor OUTSIDE of the United States?
Yes
No
N/A

I have read and agree with Interconnecting Circles & Communities' terms of service.

Select one
Yes
No

STAY CONNECTED

Sign up for our newsletter and be the first to know about new services, member benefits, and special offers.

Thanks for submitting!

By submitting your email, you agree to our Terms of Service and Privacy Policy.

Disclaimer: Interconnecting Circles and Communities does not prepare, present, or prosecute VA claims.

LET'S CONNECT

info@connectingcirclesllc.com

1.800.793.6838​

TERMS & PRIVACY POLICY

  • Instagram
  • Facebook

© 2025 by Interconnecting Circles and Communities

bottom of page