Quick Assessment Request A Free Consultation Schedule a Phone Consultation! Provide the requested information, then choose your preferred call time (after form submission) and we will reach out to you! Consultation Request First Name Last Name Email Phone Number AddressAddress Line 1 Address Line 2 City State Zip Code Choose The Service You Need: - Select A Service -Social Security DisabilityAutomobile AccidentsHave you hired an attorney for Social Security Disability? Yes NoAre you receiving Social Security Disability or Retirement? Yes NoDo you have a pending Social Security Disability application? Yes NoDo you expect to be unable to work for more than 12 months? Yes NoHave you worked 5 of the last 10 years? Yes NoWhen Did You Last Work? (An estimate is fine!) Still working Within the last two years 2-5 years ago 5+ years agoWhen was your last appointment with your doctor, nurse practitioner, or counselor? (An estimate is fine!) 0-6 months ago 6-12 months ago 12+ months agoHow many doctors have treated you in the last 5 years? Please include nurse practitioners and counselors as well. No treatment 1-5 Doctors 5+ DoctorsHow many prescribed medications are you currently taking? None 1-5 Medicines 5+ MedicinesWhat is Your Age? Over 62 54 - 62 49 - 53 40 - 48 Under 40Notes Location of Accident Date of Accident Number of Vehicles Involved Driver(s) Faulted in Accident Report Insurance Medical Bills Accident Description Medical Treatment Submit Form Unparalleled Customer Service My office staff will help you fill out all the necessary forms to make sure your application is processed as quickly as possible. 27 Years Of Experience I opened my practice in 1994 and have helped thousands of clients get the results that they deserve. Defining Success With a success rate of over 80%, I know how to represent my clients successfully.