Brookdale Form

Referrals to Veterans Home Care’s VetAssist Program from Brookdale DFW

Brookdale Senior Living staff members in the Dallas-Ft. Worth area may use this form to refer wartime veterans or their surviving spouses to the VetAssist Program.

Callers to Brookdale who are wartime veterans or the surviving spouses of wartime veterans with limited income and assets who need in-home care, may qualify for assistance.

If you have any questions, please contact Eric Leonard, Veterans Home Care Territory Manager at eleonard@veteranshomecare.com or 817-877-1620 or our national referral number 888-314-6075.

Name of Brookdale Employee Referring a Client to Veterans Home Care*
First Last
Company/Organization (Agency franchises: Please include branch name)*
Address of the Referral Source (You)*
Street Address City State ZIP Code
Your Contact Phone Number*
✓ Valid number ✕ Invalid number
(We may have more questions)
✓ Valid number ✕ Invalid number
Your Brookdale Division*
Your Email Address*
Name of the Senior Veteran or Spouse that You Are Referring to Us.*
First Last
Phone Number of the Senior You Are Referring to Us.
✓ Valid number ✕ Invalid number
Address of the Senior That You Are Referring to Us.
Street Address City State ZIP Code
Next of Kin Full Name:

The name of a family member. (Full name)
Next of Kin Phone:

Phone for next of kin.
Next of Kin Email:

Email address for next of kin.
Next of Kin Relationship to Senior Veteran or Spouse Needing Care

spouse, daughter, daughter-in-law, son, son-in-law, niece, nephew, cousin, friend, etc.
Who should we contact? The senior or their next of kin?*
- Contact the Senior
- Contact Next of Kin
In which war did the veteran serve?*
The veteran must have served during wartime.
Information/Comments
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The VetAssist® Program is offered exclusively by the Veterans Home Care® family of companies.
Veterans Home Care® and the VetAssist® Program are not part of any government agency and are not affiliated with the Department of Veterans Affairs (VA).

Veterans Home Care, LLC | Veterans Home Care of California, LLC | Veterans Home Care NYJ, LLC | Veterans Home Care of Texas, LLC | VetAssist, LLC | VetAssist Atlantic, LLC | VetAssist Central, LLC | VetAssist Nevada, LLC | VetAssist Pacific, LLC | VetAssist West, LLC