I have filled out the form with my address and the sections that define the reason the information is requested, the scope of the request as the entire VA file, that the information can include sensitive information, and the expiration condition.
In the left margin, you will see a circled 1, 2, and 3. Each block needs your attention to complete the form.
Block 1 and 2 need your Last Name, First Name, Middle Initial, the last 4 of your social security number, and then your birthday.
Block 3 needs your signature and date.
After you have signed the form, then you should contact the medical records office of your VA clinic or hospital to request your files.
Please make sure that the records are mailed directly to my office from the VA.
If the records are given to you directly, and you transfer the file to me, the packet may no longer be useful since I can no longer verify that the file represents the entire, unaltered record.