If you wish to hire me to advise you on your case fill out this form. It provides a more complete view of your circumstances and I can give you a better opinion of your case.
Your Name (required)
Your Email (required)
Your Phone Number (required)
Your Mailing Address (required)
Best Time to Call (required)
Do you expect to be out of work for at least 12 months? YESNO
Do you already receive Social Security benefits?
Is an attorney already helping you?
Are you currently under the care of a doctor?
How many years have you worked in the last 10 years?
What is your medical condition that prevents you from working?
Notice: Your personal information is strictly confidential and secure. Upon submitting this form, you will receive an email and/or a phone call to discuss your case.