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The form must be completed electronically; handwritten forms will not be accepted.
The collection of personal information is governed by the Privacy Act of 1974 and other relevant U.S. laws, ensuring confidentiality.
Information collected aims to identify mental health concerns and facilitate referrals for additional assessment or care if necessary.
Providing information is voluntary; however, declining to provide requested information may result in administrative delays or inadequate care.
The form includes detailed questions regarding mental health history, stressors, alcohol use, PTSD symptoms, and depression screening.
Based on responses, healthcare providers can recommend referrals for further evaluation or treatment for mental health issues.
The form allows users to request various support services including counseling, chaplain visits, and assistance with family or relationship concerns.
