Social Security Disability Evaluation Form





The form below allows you to request a free Social Security Disability benefits evaluation. Complete the form below and a member of the law firm of Sheri R. Abrams will review your case and email or call you to let you know if, in our opinion, you may be eligible for benefits. Please note that we are very selective as to the cases that we take.

Name (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Email Address (required)

What is your age? (required)

Have you applied for or are you receiving Social Security Disability (SSDI) or Supplemental Security Income (SSI) benefits, or both? (required)

What stage are you in the Social Security Disability process? (required)

Date of most recent denial letter from Social Security? (required)

Please feel free to attach denial letter if you would like:

Is an attorney or advocate helping you with your Social Security case? (required)
YesNo

Have you applied for or do you receive any other types of Disability benefits, such as Federal Government Disability (FERS), or Worker’s Compensation? (required)
YesNo

Are you working now? (required)
YesNo

If no when did you Last Work? (required)

Are you receiving unemployment benefits now or since you stopped work? (required)
YesNo

How many years have you worked in the last 10 years? (required)

What type of work did you do? (required)

Are you currently under the care of a doctor? (required)
YesNo

What type of Doctor(s) are you seeing? (required)

Has this doctor(s) stated that you are unable to work? (required)
YesNo

What prescription medications are you taking? (required)

What is the medical condition that prevents you from working? (required)

If you are having trouble sending us this form, please download this form, fill it out, save it, and return it via email to ashley@sheriabrams.com or fax it to (703) 218-8147.