VETERAN PRE-QUALIFICATION FORM
Email your DD214 to: Shaunnesy@wellness4warriors.org
As proof of eligibility, please email your DD214 form. Your information will be reviewed, and we will contact you if we need additional information.
Our goal is help veterans with natural alternatives. (Once we receive your DD214 as verification we will delete the form and will not be shared with anyone else.)
(C) 2018 Wellness 4 Warriors. All rights reserved.
If you are a United States veteran and are seeking help through natural methods, please complete and submit the form below.
Please provide and answer ALL questions and email your DD214.
(Once we receive your DD214 as verification we will delete the form and will not be shared with anyone else.)
Answers provided in the COMMENT SECTION
1. How did you hear about Wellness 4 Warriors? (Facebook, Website, etc.)
2. Health challenges: PTSD, TBI, Pain, Sleep Apnea, Insomnia, Diabetes, Neuropathy, Pain, etc
Do you have a electrical stimulator anywhere in your body?
3. Do you currently have:
- Water Filtration in your home (what kind)
- Air Purification (what kind)
- What size bed (this is for the possibility of providing a sleep system)
- Would you wear Magnetic Gel Insoles if provided?
4. YES OR NO? Would you allow us to share your name, picture, and health challenges on social media/website? Not required to qualify.
We are aware that some people present themselves as veterans, that were never enlisted and/or never served. Stolen Valor is a federal crime and is something we take very seriously.