RAD Enrollment Form
Note:  Form must be filled completely to be processed. 

*Date of Birth (mm/dd/yyyy):
*Social Security Number:
*Military Branch:
*Era of Hostilities:
*Dates of Military Service:


*Credit Card:

*Credit Card No.

*Security Code:

*Expiration Date:

Create Secret Security Question:

Security Question Answer:

Please request my Sevice Medical Records (SMR) from NPRC

Please request my medical records from VA

Please request my service records from Vet Center

Vet Center(s) you attended


By submitting your information on this form you certify that it is correct and hereby authorize U.S. Veteran Compensation Programs, Records Archive Division (RAD) to enroll you as a member of the RAD system.  You understand that a physician, attorney, mental health provider, and others associated with your medical records is may request copies of your records. You understand that your records will only be released by your signing a Release of Information and correct response to your security question. You also understand that a monthly maintenance fee of $3.00 will be deducted from your credit card or debit card for this service.  All card processing will be processed through our PayPal credit card service.  A photcopy of this authorization shall be considered valid as the original.