Social Security Disability Claim Evaluation

Wednesday, July 27, 2011 @ 12:07 PM
Author: Eric Jones Law
If you are considering applying for Social Security disability benefits, or if your initial application or your Request for Reconsideration has been denied, please answer the questions below if you would like us to confidentially review your case. An asterisk (*) indicates required fields.Do you have an attorney representing you now?
Yes

No

Are you working now?

Full-time

Part-time

No

What level of education have you completed?

Elementary (6th)

Middle school (8th)

High school (12th)

College

What was your most recent job?

List the medical conditions that affect your ability to work:

 

 

 

 

Explain how they keep you from working:

Name:

Date of birth:

Street address:

City, zip code:

Email:

Main phone:

Alternate phone:

Language preferred:

Best time for us to call:

Morning

Afternoon

Evening

Law Office of Eric A. Jones, LLC

Phone: 614-545-9998 or (877) SSD-IWIN

Fax: 614-224-9300

580 S. High St., Suite 100

Columbus, Ohio 43251

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