Social Security Disability in Your Area

Name*
First Last
Email*
Phone*
Address
City
State
Zipcode
Date of Birth
MM slash DD slash YYYY
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?
- No
- Yes
Are you currently collecting Social Security benefits?
- No
- Yes
Have you applied for Social Security Disability benefits?
- No
- Yes
If yes, what is the status?
Approximate date last worked regularly
MM slash DD slash YYYY
Approximate date became disabled
MM slash DD slash YYYY
Tell us about your disability and/or issues. We welcome your calls, letters and electronic mail.
The information you obtain at this site is not, nor is it intended to be, legal advice. Contacting us via this web at www.binderandbinder.com is not retaining Binder & Binder®. Social Security does not consider us authorized to act on your behalf until you sign a retainer and the government form 1696 that says you want us to represent you. We cannot represent you without your signature on these forms. Social Security will not allow us access to your file until we submit their 1696 government form.

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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