Veteran/Claimant Information *
Phone*
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What is your Social Security Number? *
May we communicate with you via e-mail? *
What is your marital status? *
Do you have any dependent children or parents? *
Which Branch of the Military did you serve in? *
Did you serve in the National Guard or Reserves? *
What was your character of discharge? *
Have you ever received a decision from the U.S. Department of Veterans Affairs (VA)? *
If you have a copy of the VA decision you wish to appeal, you can upload it here

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Are you currently receiving monthly benefits from the VA? *
If you are currently receiving benefits from the VA, what is the monthly amount you receive?
Have you ever been represented before by an attorney or law firm for your VA disability claims/appeals? *
What would your like our law firm to assist you with and what is your overall goal? *
Are you currently working? *
If you are currently employed, how many hours per week do you work?
Do you have a copy of your DD 214 that you can provide us with? *
If you have a digital copy of your DD 214 available you can upload it here

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How did you hear about Centonzio Law? *
If you were referred to us by someone, please tell us their name so we can thank them for the referral.
Alternate Contact Information - Please provide an alternate contact that we can reach out to if we are unable to reach you. We will not discuss any details of your case with this person.
Phone
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Email
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