The Proven Remedy

Request for VA Eligibilty Review

Location: Home > U.S. Veterans > U.S. Veterans and Active Military Information

United States Veterans and Active Military

The Alpha-Stim® technology has provided relief from emotional difficulties for many veterans and active military personnel. Currently, Alpha-Stim® models AS-100 and AS-SCS are available to you via prescription from your VA healthcare provider under authorized Federal Supply Schedule (FSS) contract number V797P-4800a. Thanks to this contractual agreement, Alpha-Stim® can help you conquer your anxiety, depression or insomnia.

We may have programs available to you if needed. If you would like to learn more about the Alpha-Stim® and how it may be able to help you, please fill out the form below to have your VA eligibility reviewed.

All required fields are marked with a star (*). Click the 'Submit' button at the bottom of this form to proceed.

Contact Information

Your Name*	Your Street Address*
City*	State*
Zip Code*	Phone Number *
Your Email Address*

Eligibility Determination Information

Do you have a service connected disability?* Yes No	Are you presently being treated at a VA?* Yes No
What is the percentage of your disability?*	What is the name of your VA or CBOC?*
What is your diagnosis?*
Additional Comments

Image Verification

Image Verification*

Image Verification

Enter the text from the image above to help combat spam. Validation of your entry is case-sensitive. If you cannot read the text above, refresh this page to view a different image.