We accept Social Security disability cases at all stages. If you are thinking about applying, have had your application denied, or have had your Request for Reconsideration denied, please answer the questions below if you would like us to review your case.

An asterisk (  *  )  indicates required fields.

*Do you have an attorney representing you now?YesNo

*Are you working now?Full-timePart-timeNo

*What level of education have you completed?Elementary (6th)
Middle (8th)
High school (12th)
College
None

*What was your most recent job?

List the medical conditions that affect your ability to work:*1.
2.
3.
4.
5.

*Explain how these medical conditions keep you from working:

*Name:

*Date of birth:

*Street address:

*City, zip code:

*Email:

*Main phone:

Alternate phone:

*Best time for us to call:MorningAfternoonEvening

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