Gulf War Veteran Resource Pages
Gulf Veteran Referral System

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A Joint Project supported by:

The GWVRP is referring individuals to the National Gulf War Resource Center. Please complete the information below to submit a contact request to the Referral Network.

Your information will be E-mailed to the NGWRC. Your email address is not databased and you will not be added to any spam lists by using this form. If you do not have your own E-Mail address, please call the National Gulf War Resource Center at 800-882-1316 x 162, between 9:00am and 5:00pm, US Eastern Time.

Fields marked with an asterisk are required.

Your Name *:
Note: You must include either Phone or E-Mail
E-Mail Address:
Phone:
Mailing Address:
Street Address:
City:
State:
Country:
Postal Code:
Your Code Is:
Enter Code *:

The following survey is optional

The information collected here may help the referral organization in assisting you.

This information is not being recorded. It will not be used for marketing or for any other purpose, except as stated.

Do you feel that you are ill as a result of the Persian Gulf war?
Yes
No

Are you a veteran of the Gulf War (includes contractors, civilian employees, etc)?
Yes
No

If No, are you related to a Gulf War veteran?
Yes
No

If Yes, what is your relation?

If you chose "Other" above, please explain:

Have you registered with either of the Persian Gulf Registries?
Veterans' Administration
Department of Defense
Not Registered

Have you filed a claim with the VA, or are you being/have you been processed for a medical discharge by the Military?
Veterans' Administration
Medical Discharge
Both
No Claim Filed

Please enter anything that may help the referral coordinator assist you:

The mission of the GWVRP is to disseminate health related information to veterans of the Persian Gulf War in an unbiased format. The site is operated completely by volunteers and is not affiliated with any government entities or programs. ©1994-2013, Shaw Avenue Consulting.