DEDICATED TO HELPING THOSE WHO HAVE SERVED OUR COUNTRY HONORABLY

 

Application
for Residency & Services

Please use the form below to inquire about residency in our programs & our services. 
After filling in the fields, click the submit button.

Name: *First Last name
Email:  
Telephone:
Current address:  
Type of discharge:
Medications being taken:
Medical Condition:
PTSD: 

Yes

No

Addictions:
Rehabs:
Please select your location preference: 
Other comments / questions / benefits:

 

United Veterans
Beacon House, Inc
1715 Union Blvd.
Bay Shore, NY 11706
Phone: (631) 665-1571
Fax: (631) 665-1578
mailto:info@uvbh.com