Get Help with your Disability Claim

Are You Disabled?

If you need help with your Social Security Disability benefit claim, complete the Free Case Evaluation Form and a Disability Advocate will contact you to discuss your case.

Have you already applied for Disability benefits?

Yes   No

Are you being treated by a doctor for your disability?

Yes   No

Go to Step Two

Step 2 of 4

Do you have a disability that prevents you from working full-time for at least 12 months?

Yes   No

Type of Disability:

+ + + + + + + Physical Disability Mental Disability Physical and Mental I don't have a disability

Please tell us about your disability:

Go to Step Three

Step 3 of 4

Have you worked 5 out of the last 10 years?

Yes   No

Is an attorney or advocate helping you with your disability case?

Yes   No

Go to Last Step

Step 4 of 4

First Name:

Last Name:

Applicant's Age:

+ + + + + + Under 18 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Over 65

Street Address:

Zip Code:

Phone Number:

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Email:

By submitting my information, I agree to the Terms & Conditions and I consent to receive autodialed and/or pre-recorded marketing calls and text messages from or on behalf of MyAttorneyHome or their attorney network at the number(s) above to discuss my potential options. I understand that consent is not a condition of purchase.

Get Your Evaluation!

Please Note: Filling out the free case evaluation form is not applying for Social Security Disability benefits through the Social Security Administration.

If you are disabled the first step is to Apply for Social Security Disability benefits with the Social Security Administration. You can only apply for benefits in person through your local Social Security Administration office, by calling 1-800-772-1213 for help by phone, or online at www.socialsecurity.gov