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Free Social Security Disability Evaluation

Please fill out our Secure FREE Social Security Disability Form.
One of our representatives will contact you within 2 business days.

Title

Name

Email

Telephone Number

Address

Date of Birth (If you do not wish to enter your date of birth, please complete Age Range field)

Age Range

What type of doctors are you currently seeing? List all.

Do your doctors think you are disabled? If so, which ones

Are you currently working?

Yes

No

Are you currently collecting Social Security benefits?

Yes

No

Have you applied for Social Security Disability benefits?

Yes

No

If yes, what is the status?

Approximate date last worked regularly

Approximate date became disabled

Is there a pending Social Security case pending? Please select one.

SSI

SSD

Both

None

If a pending case exist, what is the status?

Tell us about your disability and/or issues

The information you obtain at this site is not, nor is it intended to be, legal advice. We invite you to contact us and welcome your calls, letters and electronic mail. Contacting us via this web at www.binderandbinder.com is not retaining Binder & Binder. You are not a client until you sign a retainer and the government form 1696 and return them to us. If there are deadlines to file an appeal, DO IT NOW.  We cannot file any appeal nor can we act on your behalf until you retain us and authorize us to handle your social security case.


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