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?
Have you applied for Social Security Disability benefits?
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 the law firm. 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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