You fought for our country.

Let us fight for you!

VBS at Axxess Medical Solutions aims to help our veterans through our independent Veteran Benefit Services by giving veterans control over their disability claims.

Documents you will need:

1. DD214 A document of the United States Department of Defense, issued upon a military service member's retirement, separation, or discharge from active duty in the armed forces of the U.S. Equipment Group: U.S. Air Force, U.S. Space Force, U.S. Army, U.S. Coast Guard, U.S. Marine Corps, or U.S. Navy.

2. A COPY OF YOUR DRIVER’S LICENSE OR PICTURE ID

3. COPIES OF ALL OF YOUR DECISION LETTERS- these are letters from the VA that state what you are service connected/denied for, how, and why

The Engagement Packet must be completed and returned to Axxess Medical Solutions with copies of your DD214, decision letter(s), your state ID or valid driver's license, as well as your commitment and a non-refundable deposit.

TIPS TO HELP YOUR CASE:

1. Call the VA Hotline for your state and ask to open an Intent to File and know what date it was opened.

2. Go to VA.Gov and create an ID.Me account. Please remember your log in.

CONTACT US TODAY

IF YOU HAVE ANY

QUESTIONS

AXXESS MEDICAL SOLUTIONS

151 Southpark Rd., Ste 101

Lafayette LA 70508

vbs@axxessmed.com

337-484-1178

Dear Veteran:

We are pleased that you have entrusted Axxess Medical Solutions (AMS) to help you with maximizing your veteran disability benefits. This letter is intended to describe the terms, conditions, and scope of services Axxess Medical will be retained to provide during this engagement.

1. Veteran Benefits Services

Our goal is to provide you with medical services of the highest quality and efficiency; to provide the medical assessments required to establish a fully developed claim. The scope of work will include medical evaluations, research, medical reporting and procedural support to ensure contentions are optimized.

Veteran Benefits Services (VBS) will include any combination of the following, based on the individual need of the veteran. The service required could include all or some of the following, based on whether the claim is new or a rejected claim that needs to be amended and submitted:

● Initial Screening Questionnaire

● Completion of the required DBQ's

● Research required to support the medical conclusions in the Nexus Letter

● Technical writing of the Nexus Letter, including medical opinion and rationale.

● Complete Claim Decision Follow up and Support

2. Program Economics

A complete explanation of program cost, payment options and value, you can contact Axxess Medical Solutions as follows:

● Contact your VBS recruiter

● Contact the office at (337) 484-1178 and ask for an Intake Coordinator

● Email us as vbs@axxessmed.com

3. Veteran Expectations

The VBS @ Axxess Medical Solutions disability claim process has been developed and refined over the past 10 years. It will provide the veteran with a Fully Developed Claim (FDC) including all supporting medical diagnosis and service connections to substantiate the claim. However, approval and ratings for the veteran's claim is at the sole discretion of the VBA. Axxess Medical is not providing any guarantees or warranties inferred or otherwise for the completed disability claim.

Should the VBA deny a claim, Axxess Medical Solutions can and will assist the veteran with the appeals process. Each claim is independent and specific to the veteran; therefore, the appeals process is also unique to the veteran. The appeals process could involve any of the following steps:

● review of decision letter

● additional research

● revision of existing claim

● formal request for a Higher Level Review (HLR)

● Submittal of new and relevant evidence (Supplemental claim)

4. Payment Terms

Axxess Medical Solutions provides medical services that are not typically covered by conventional medical insurance. Therefore, payment for services is due at the time of service. Your fully prepared packet will be available for you to submit only when AMS has received payment in full.

The total cost for our service in providing you with a Fully Developed Claim is $5,000.00. Upon receipt of your commitment to our program, if you choose to self-pay, there will be a $1,000 deposit after which we will send out your initial screening questionnaire.

If you should cancel, please call the office at 337-484-1178 within 24 hrs prior to your appointment. If no cancellation notice is received, there will be a $75 late cancellation fee.

The remaining balance of our service will be due in two payments of $2,000 each. The second payment will be due at the time of your Disability Benefits Questionnaire appointment with the final payment being due upon pickup of your Fully Developed Claim packet.

5. Disclaimer

Axxess Medical Solutions is not accredited or associated with the DVA or VA in any way. We do not claim to be attorneys or give any legal advice. We do not claim to be VSO’s or VSA’s. Axxess Medical Solutions only provides medical diagnosis and independent medical opinions. Axxess Medical Solutions is a for profit organization. As such, Axxess Medical Solutions does not in any way guarantee or promise a client will receive any remuneration of disability benefits.

Print Name *

Signature *

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Date *

Personal Information

Please type or write legibly

Please include a copy of your state ID or driver's license.

Upload Copy Of ID Here

Name *

Email *

Phone *

Address *

Street Address

City

State

Country

Postal code

Date of Service Start *

Date of Service End

Have you ever been deployed overseas? *

If so, please provide dates and locations of deployment below

Please list your MOS and job description below *

Are you service connected for any disabilities? *

If yes, please list any service connected claims and their relevant rating percentage below.

AMS FINANCING OPTIONS:

Affirm

● https://www.affirm.com/how-it-works

● 3-60 month terms available

● Interest free options available

● Affirm card in mobile wallet required

● Soft Credit Check

● Quick Approval

EXISTING ACCOUNT REQUIRED

Care Credit

● www.carecredit.com/apply

● 12-60 month terms

● Payments range from $135-$250 monthly

● Immediate Credit decisions

● Accepted across 270,000 medical providers

● Can be used for most medical service

Self Pay – (3) Incremental Payments

1. Initial Screening Questionnaire

2. Completion of Disability Benefits Questionnaires (5-7 each)

3. Completed Fully Developed Claim

Fully Developed Claim submitted ONLY after payment in full

CREDIT CARD AUTHORIZATION FORM

Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until canceled. Upon receipt of this authorization form, a $1,000 deposit will be collected, after which we will send your initial screening questionnaire. Veterans entered into our program under our Buddy Program will have a deposit of $500 with $250 added to each of the two remaining payments.

CREDIT CARD INFORMATION:

CARD TYPE: *

Cardholder Name: *

Card Number: *

Expiration Date: *

CVV: *

Cardholder ZIP Code (from card billing address): *

I authorize AXXESS MEDICAL SOLUTIONS to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.

Signature *

Clear

Date *

Disclaimer:

This website may collect personal information that you voluntarily provide through forms such as contact, questionnaire, appointment scheduling, or newsletter sign-ups. Any information you submit is handled with strict confidentiality and safeguarded in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable privacy laws. We do not share, sell, or disclose your personal health information without your explicit consent. Please note that submitting information through this website does not establish a doctor-patient relationship.