Welcome The Village at Valley View.

Thank you for working with Patriot Angels. Please fill out the following form to create a lead in our system. To aid the process please provide as much information as possible.

Date Entered Into Service:
Date Released From Service:
Did the Veteran receive an Honorable, Medical, or General Discharge?  
Do you have an ORIGINAL or CERTIFIED COPY DD-214?  
Leave Blank if None - Click and Drag to Select Multiple or Hold Ctrl and Click
Have you ever applied for Aid & Attendance?  
Have you ever been denied A&A?  
Are you receiving anything from the VA currently?