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Frequently Asked Questions: How can I find a social security lawyer? How does social security determine if I am disabled? Who can get social security disability? How do I apply for social security? When can I appeal my case if I am denied? Where can I find medical information about social security? Should I retain a lawyer to represent me? Do I qualify for social security? What is "disability"? How can I speed up my social security claim? How many appeal levels are there for social security? What are some social security recourses?

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If you have questions regarding your claim, or would like to be informed of your rights please fill out our "Social Security" form below.

Once we receive your information below, we will personally evaluate your case, and contact you to further discuss your situation.

There is no cost or obligation for this service.

Title:*	First Name:*	MI:	Last Name:*

Email Address:*	Home Phone:*
(ex. janesmith@yahoo.com)	(ex. 555-505-5555)
Work Phone:	Mobile Phone:
(ex. 555-505-5555)	(ex. 555-505-5555)
Address:	City:

State:	Zip:
	(ex. 02052)

Date of Birth:

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Your Name:
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Claim Status:
Have not applied
Have applied but have not received a determination
Have applied and been denied
At original claim
At reconsideration
At hearing stage

How many times have you previously filed?
1   2   3   4   5 or more

If denied, what level?
Initial
Reconsideration
Administrative Law Judge
Appeals Council

Most recently denied:

Date you became disabled:

Have you worked 5 out of the last 10 years? Yes   No

Last date you worked:

Are you working? Yes   No

Disability:

Physical / Mental Limitations:

Conditions & Symptoms:

Back Injury
Neck Injury
Hip Injury
Knee Injury
Foot Problems
Asthma
Bronchitis
Sleeping Problems
Depression Disorder
Epilepsy
ADD
ADHD

Heart Problems
Poor Circulation
Nerve Problems
HIV
Hepatitis
Mental Illness
Anxiety Disorder
Panic Attacks
Bi-Polar
Multiple Sclerosis
Concentration Problems
Memory Problems

Are you being treated? Yes   No

Do you have an attorney? Yes   No

Is the injury work-related? Yes   No

Medications:

Other claims:
Workers Compensation
Long Term Disability
Personal Injury
Medical Malpractice
Other

Case Information:

Case Description:

Comments/Additional Information:

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