We handle Social Security Disability and SSI cases at all levels including
administrative appeals, cessation, overpayment and federal court appeals.  
Please give us some information about your matter:

Social Security Questionnaire

Name:
Address:
City:
State:
Zip:
Email address:
Telephone Number:
Best time to call:

 

What type of SS case do you have?

SSD SSI Both Other

If you indicated “Other” please state what your Social Security matter is:

If you are trying to get disability benefits tell us:

What are your physical or mental impairments that keep you from working?

Have you applied for SS Benefits? yes no

When did you apply?
When were you last denied?

What level last denied you?

Initial Application
Reconsideration
Administrative Law Judge Hearing
Appeals Council
U. S. District Court
U. S. Court of Appeals

Have you received workers compensation benefits since the date you became disabled? yes no

If yes then tell us:

Beginning date you received workers compensation:
Ending date you received workers compensation:
or to present

When did you last work?
What kind of work did you do?

Are you working now? yes no
If yes how much do you make per month on average
$ /month.
What kind of work do you do now?

 

How were you referred to us?

TV
Yellow Page
White Pages
Friend
Lawyer or Doctor
Other
Saw Victor Makris speak in a seminar

If a person referred you to us please state their name: