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Social Security Disability Lawyer – 35 Years Experience
(818) 502-9056
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Select your case type
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SSDI (Social Security Disability Insurance)
SSI (Supplemental Security Income)
What is your zip code?
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What is your relationship to the applicant?
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Please select an option
Self
Family Member
Other
Applicant's Age:
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When did the condition first begin to affect the applicant?
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Please select an option
1 year ago
1-3 year ago
3-5 year ago
over 5 years ago
Has the applicant been forced to stop or reduce work hours?
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Please select an option
Yes
No
Is the applicant currently being treated by a doctor?
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Please select an option
Yes
No
Has the applicant previously applied for social security disability?
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Please select an option
Yes, Claim Pending
Yes, Claim denied
No
Briefly describe your medical impairments:
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List all jobs performed in last 15 years for which you have earned more than $12000 per year?
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What is the applicant's first name?
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What is the applicant's last name?
Prefered method of contact:
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Please select an option
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What is the applicant's telephone number?
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What is the applicant's email address?
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(818) 502-9056
315 Arden Ave, Suite 10 Glendale, CA 91203
Claim@AslanDisability.com
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