We hope to build a congressional packet - a packet of information from the families of
Operation Iraqi Freedom and Operation Enduring Freedom Veterans which will be sent to
each and every member of the United States Senate and House of Representatives.  The
packet will include statistics, stories from Veteran families, a list of needs, and suggestions
for solutions.  The only way for all of us to have the resources and support we need is to
tell those in the position to change things how they can help!

Please fill out the survey as completely as possible.  If you don't mind including your
name and contact information, please do.  However, it is not required.  The survey
should take 10 - 40 minutes.  We truly, sincerely need this information from as many
families as possible in order to make sure our suggestions and requests cover everyone's
needs.  We know it may seem like a lot of questions, but they all go together to form an
overall picture of the needs of our many, many Veterans and their loved ones.

If you have friends or family members who are also OIF/OEF Veterans or family
members, please CLICK HERE to send them an e-mail telling them about this survey.
(Note - The "E-mail a Friend" service is completely confidential.  The addresses you
include will not be recorded or used for any future purposes!!)

We are also looking for five families who are willing to let us use their story, background
details, etc., as part of the congressional packet to put a "face" on issues affecting the
families of our Veterans.  If you are willing to participate, please check the box at the
bottom of this form and then complete our "Share Your Story" form.

Thank you, in advance, for your help!!
Your Name:
If you are willing, please enter your first & last name.  If not, please enter your "alias." MAKE SURE to use the same alias on all forms!!!
Your State:
 Your Zip Code:
If you currently live overseas, please enter the country.
 Let's us calculate how close you are to VA & other resources.
E-mail Address:
If you would like to receive ongoing updates about this survey and FamilyOfaVet.com,
PLEASE CLICK HERE.  A separate window will open a sign up form for our e-mail newsletter.  
No worries though, we will not share your e-mail address with anyone, ever... period!
Are you a...
 Veteran
 Spouse Of
Veteran
 Child of
Veteran
 Parent of
Veteran
 Other
Loved One
What war / campaign did the Veteran serve in?
(Check all that apply)
 Operation Iraqi Freedom
(Iraq, Kuwait, etc.)
 Operation Enduring Freedom
(Afghanistan, etc.)
What branch did the Veteran serve in
during his/her deployment?
(Check all that apply)
 Air Force (Active Duty)
 Army (Active Duty)
Marines (Active Duty)
 National Guard
Navy (Active Duty)
 Reserves
How many times has the Veteran been deployed?
Approximate date(s) of deployment(s)?
Example: April 2002 - May 2003, January 2004 - January 2005
If the Veteran was a member of the Active Duty element of the Air Force,
Army, Navy or Marines, is he or she still part of an Active Duty force?
Yes
 No
If he/she is no longer Active Duty, what was their ETS date (the date
they left the military)?
Example: November 2006 or MM/YY
Has the Veteran been diagnosed with PTSD?
 Yes
 No
If the Veteran has not been diagnosed, does
he/she have symptoms of PTSD?
 Yes
 No
Has the Veteran been diagnosed with TBI (Traumatic Brain Injury) or MTBI
(Mild Traumatic Brain Injury)?
 Yes
 No
If Veteran has not been diagnosed with TBI or MTBI, was Veteran part of any
blast attacks (IED's, RPG's, VBIED's, Mortars, etc), which resulted in a loss of
consciousness lasting less than 30 minutes?
Yes
 No
Did the Veteran sustain major physical wounds or injuries during
deployment?
 Yes
 No
Did these wounds or injuries cause the Veteran to have to leave the military?
 Yes
 No
Is the Veteran experiencing any "unexplained" physical symptoms (ongoing
diarrhea / intestinal issues, recurring sinus infections, strange rashes, etc.)
 Yes
 No
If yes, what symptoms is the Veteran experiencing?
Do you plan to "Share Your Story" for us to possibly include in the
congressional packet? (for more info, see explanation at top of page)
 Yes
 No
IMPORTANT:  This survey is made up of several different forms, so that you only have to answer the questions that apply
to you!  If you are not going to submit your name, please use a nickname or pretend "alias" and use the same name on
every section.  That way, we can put all of your answers together.  This is very, very, very important!!

Help Us Help You!
FamilyOfaVet - Real world info about PTSD, TBI, & life after combat
FamilyOfaVet - Real World info about PTSD, TBI, & life after combat.
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