Company Step 1 4 Easy steps. We promise this will not take long. You're here because you think social security disability is pretty important to you, right? The more detail we get, the more we can help you! Do you have an attorney or representative helping you on your social security disability claim? * Yes No Step 2 Your on your way now! Please know all the information you provide is strictly confidential. 5. Have you previously submitted an application for Social Security Disability Insurance (SSDI)? * Yes No 6. What date did you file your application for SSDI? If you do not know the exact date, please use an approximate. 7. What medical condition or medical conditions do you have that result in an inability to work? * Back problem Mental problems Cancer Arthritis Other 8. How far have you gone in school * Did not receive a Highschool Diploma Received GED High School graduate Some college but no degree College graduate 9. Describe your past work (can select more than 1) * Unskilled Manual, Hard Physical Labor Semi-Skilled Skilled Sedentary (sit down job) Clerical Professional Step 3 Half way done! 10. Have you had surgery or procedures for the condition that keeps you from working? * No Treatment Surgery Physical therapy Medication Other 11. Do you see a doctor regularly now for the condition that keeps you from working? * Yes No 12. Do you see a specialist regularly now for the condition that keeps you from working? * Yes No 13. Do you now take medications for the condition that keeps you from working? * Yes No 14. Have you worked and paid social security taxes for at least 5 of the last 10 years? * Yes No Last Step You're almost done! 15. Are you now enrolled, or have you ever been enrolled in a vocational rehabilitation program? * Yes No 16. If you have depression or anxiety do you see a psychologist or psychiatrist (even if depression and anxiety are not the conditions that keep you from working) * Yes No 17. Do you smoke? * Yes No 18. Do you abuse alcohol or use any illegal drugs (even marijuana)? Remember your answers are completely confidential. * Yes No 19. Have you ever been incarcerated or convicted of a felony? * Yes No Thank you! This assessment is based upon Mr. Denman's 25 years of experience handling only social security disability case in Dallas Fort Worth Texas. Please know, however, that is it generic and general in nature, and is not intended to replace personal attorney advice. Would you like attorney Stanley Denman to contact you? There is no charge. How would you prefer to be contacted? Your name * Preffered method of contact * Phone E-mail captcha