Practice Concentrated

in Social Security Disability Law

Contact Us Today To Evaluate Your Disability Case

Please fill out the following form as completely as possible in order to assist us in evaluating your disability case.

Contact Information

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Employment

*Are you working full time?
 Yes No
If no, when did you stop working full time?
During the ten years before you stopped working, how many of those years were you employed?
Are you working part time?*
If you are still working part time, please answer the following:

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Social Security

Have you applied for Social Security? *
 Yes No
If your case has been denied, what is the date of the MOST RECENT denial notice?
Have you filed an appeal of this latest denial notice?
 Yes No
If you have applied, are you currently represented
by an attorney?
 Yes No
Are you currently under the care of a doctor?*
 Yes No
Please describe your disabilities and
why you feel you cannot work:

I am so happy! Thank you for helping me with my case. You made everything go so smoothly. No I know why you are 'number one' in Chicago. I will surely send qualified friends and family your way when they need your help. Thanks again.

Suzanne K.