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Get Help from IAVA’s Rapid Response Referral Program

Get Help from IAVA's Rapid Response Referral Program

Thank you for reaching out to IAVA’s Rapid Response Referral Program (RRRP). Below are our intake questions which will help us determine how we can best assist you. All of your responses are confidential unless you express intent to harm yourself or someone else. Thank you again for reaching out and we look forward to working with you.


Someone from our RRRP Team will be in touch within 1-2 business days. With that in mind, please submit this form only once within that window.


If you are already working with a case manager and have been asked to complete this form, please do so only once. Any further updates should be directed to your case manager.


If you are currently experiencing a crisis please call the Veterans Crisis Line at 1.800.273.8255, and press 1. If you need immediate medical attention, please call 911 or go to your nearest emergency room.

Please review our terms before completing our intake form.

Terms of agreement:


Services: IAVA’s Rapid Response Referral Program (RRRP) is a referral service with an intensive remote case management component. We provide support and help connect veterans and family members with resources via e-mail and phone. For more information, please click here.


Confidentiality/Client Rights: We abide by the laws and ethical principles that govern privilege and confidentiality. We provide services via e-mail and phone and although we will do our best to safeguard information, there are limitations and risks associated with such services. We will not discuss any information about you with anyone without your written permission by way of a signed Release of Information. There are some exceptions to this standard:

  • All of your responses are confidential unless there is an indication that you are at risk to yourself or someone else.
  • We are legally required to report suspicions of ongoing child, elder and disabled person abuse.
  • We may have to release your records when ordered to do so by court subpoena. However, we will discuss this with you beforehand and request a written release of information from you, if we judge this to be in your best interest.


Social Media: IAVA has an online presence and RRRP’s case managers will not accept friend requests from clients, past or present, on all online and social media platforms, including LinkedIn.


Why are you reaching out to RRRP


Demographic Information












Military Information

Veteran - Service Details







Please write "Infantry" instead of 11B/0311, etc.





Your connection with the Department of Veteran Affairs












If you are a veteran family member reaching out on behalf of yourself and/or your family, please complete the following section with your veteran family member's information to the best of your ability.








Please write "Infantry" instead of 11B/0311, etc.





Tell us about the veteran's connection with the Department of Veteran Affairs












Home, family and employment










What is the total amount of earned income for your household. This includes your spouse and working dependents.
Physical & Mental Health Needs