Information if you're affected by coronavirus (COVID-19).
Lifestyle questionnaire
Form ID:
D2669
Audience:
General
Complete this form if you want the Department of Veterans’ Affairs to assess a lifestyle rating for you based on the information you provide.
If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.
How can I access this form?:
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