REFERRALS If you are a veteran, or know a veteran, who is having a difficult time with civilian reintegration and would benefit from the assistance of DAH, please fill out the form below with the contact information of the veteran you wish to refer. VETERAN REFERRAL INFORMATION Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *Email *Address *Line 1Line 2City *State *Zip Code *Please provide a short description of the veteran’s needs.Agency NameCase Manager's NameCase Manager's Phone NumberCase Manager's Email AddressI am...Referring myselfThis Veteran's case managerOther (Please specify below)If "other", please specify your relationship to the referred VeteranSubmit