Military Discharge Upgrade Intake Form

Please fill out this form as best as possible. This gives me the ability to evaluate the best way to handle the details of your case. If you do not know an answer, you may skip it.

Also, there are several personal questions about place of birth and SSN. These questions allow me to make a records request so we can start immediately working on your case. If a question does not relate to your case, you may skip it.

Social Security Number (Required for Application and Records Request)

What city and state were you born?

Phone Number where you receive Text Messages

Which Service were you or are you in?

What day did you enter military service?

When did you get out of the service?

What was your rank at the time of discharge?

What was your highest rank held?

What were your major duty locations during service? (List all major duty stations)

What type of discharge did you receive? Why?

What were you charged with? Explain the Circumstances.

Were you discharged through an administrative process or court-martial?

Do you have good character references? What are their names and contact info?

If you hire our firm, what are your goals that we need to achieve?

What specific goals do you hope to achieve with a discharge upgrade (e.g., access to VA benefits, removal of stigma, correction of records)?

Do you have your DD 214 or 215?

What paperwork do you have regarding your case?

Where have you been stationed during your military career?

Where were you stationed last?

What was your last unit of assignment?

Were you ever in the Reserves or Active Guard?

What specific events led to your discharge? Please provide as much detail as possible.

Were there any investigations, legal proceedings, or charges involved in your discharge? If yes, explain.

Do you have any supporting documentation related to the circumstances of your discharge (e.g., letters, evaluations, performance reviews, witness statements, etc.)?

Have you been diagnosed with any of the following (select all that apply):

Elaborate if you selected 'Other medical or psychological conditions' in the previous question.

Were any of these conditions diagnosed during your military service?

Did you seek or receive treatment for these conditions while in service?

Have you accessed treatment or received a diagnosis for these conditions after your discharge?

Do you believe behavioral health issues, to include PTSD, TBI or Military Sexual Trauma MST, had any influence on your discharge? This would include self medication type behavior.

Do you have any documentation related to your medical or behavioral health history?

Have you ever applied to the review board before?

Were your behavioral health issues a result of your military service?

How did they impact your military service?

Were there any personal challenges or hardships during your service (e.g., family issues, financial struggles, illness)?

Do you believe you were treated unfairly or harassed during your service? If yes, describe in detail.

Were there any procedural errors or improper actions taken during your discharge process?

What have you been doing since your discharge (employment, education, community service, etc.)?

Do you have any criminal record post-discharge? If yes, please provide details.

Have you pursued higher education, certifications, or completed training since your discharge?

Have you received any awards, commendations, or been recognized for achievements since your service?

Do you need assistance obtaining military and medical records to support your case?

Are you currently working with an attorney or veterans’ advocate?

Do you have any pending applications with the Department of Veterans Affairs (VA)?

Was your case reviewed through a Medical Evaluation Board (MEB) process?

If yes, describe the outcomes or unresolved issues.

Do you authorize our legal team to request and review your military and medical records for the purpose of this case evaluation?

Military Discharge Upgrade Intake Form

First Name

Middle Name

Last Name

Email

Social Security Number (Required for Application and Records Request)

Date of Birth

What city and state were you born?

Phone Number where you receive Text Messages

Mailing Street Address

Mailing City and State

Zip Code

Which Service were you or are you in?

What day did you enter military service?

When did you get out of the service?

What was your rank at the time of discharge?

What was your highest rank held?

What were your major duty locations during service? (List all major duty stations)

What type of discharge did you receive? Why?

What were you charged with? Explain the Circumstances.

Were you discharged through an administrative process or court-martial?

Were you discharged through an administrative process or court-martial?

Do you have good character references? What are their names and contact info?

If you hire our firm, what are your goals that we need to achieve?

What specific goals do you hope to achieve with a discharge upgrade (e.g., access to VA benefits, removal of stigma, correction of records)?

Do you have your DD 214 or 215?

What paperwork do you have regarding your case?

Where have you been stationed during your military career?

Where were you stationed last?

What was your last unit of assignment?

Were you ever in the Reserves or Active Guard?

What specific events led to your discharge? Please provide as much detail as possible.

Were there any investigations, legal proceedings, or charges involved in your discharge? If yes, explain.

Do you have any supporting documentation related to the circumstances of your discharge (e.g., letters, evaluations, performance reviews, witness statements, etc.)?

Have you been diagnosed with any of the following (select all that apply):

Elaborate if you selected 'Other medical or psychological conditions' in the previous question.

Were any of these conditions diagnosed during your military service?

Did you seek or receive treatment for these conditions while in service?

Have you accessed treatment or received a diagnosis for these conditions after your discharge?

Do you believe behavioral health issues, to include PTSD, TBI or Military Sexual Trauma MST, had any influence on your discharge? This would include self medication type behavior.

Do you have any documentation related to your medical or behavioral health history?

Have you ever applied to the review board before?

Kurta Memo Factors

Were your behavioral health issues a result of your military service?

How did they impact your military service?

Were there any personal challenges or hardships during your service (e.g., family issues, financial struggles, illness)?

Do you believe you were treated unfairly or harassed during your service? If yes, describe in detail.

Were there any procedural errors or improper actions taken during your discharge process?

What have you been doing since your discharge (employment, education, community service, etc.)?

Do you have any criminal record post-discharge? If yes, please provide details.

Have you pursued higher education, certifications, or completed training since your discharge?

Have you received any awards, commendations, or been recognized for achievements since your service?

Do you need assistance obtaining military and medical records to support your case?

Are you currently working with an attorney or veterans’ advocate?

Do you have any pending applications with the Department of Veterans Affairs (VA)?

Was your case reviewed through a Medical Evaluation Board (MEB) process?

If yes, describe the outcomes or unresolved issues.

Do you authorize our legal team to request and review your military and medical records for the purpose of this case evaluation?