Full Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
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How did you hear about Desert Disability?
Please Select
Online Search
Maps
Social Media
Friend or Family
Referred
Which search engine did you use?
Please Select
Google
Yahoo
Bing
Other
What did you type into the search engine?
Which social media platform?
Please Select
YouTube
Facebook
Instagram
Other
Who may we thank for your business?
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How old is the claimant?
*
Under 22
23-49 years old
50-54 years old
55-66 years old
67+ years old
The claimant is not eligible for Social Security Disability.
Based on your responses, the claimant is 67 or older and therefore is not eligible to receive Social Security Disability. According to the Social Security regulations, an individual can only collect disability benefits from Social Security until the full age of retirement, which is 67. To explore any additional benefits the claimant may be eligible to receive, please contact SSA at 1-800 772-1213.
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Has the claimant worked and filed taxes for at least 5 of the last 10 years?
*
Please Select
Yes
No
Unsure
Please find out the "Date of Last Insurance"
If the claimant is not sure he or she has worked and paid taxes for at least 5 of the last 10 years, please call 1-800 772-1213 and find their "date of last insurance" by speaking to a representative at the Social Security Administration. Once you have the date, please email it info@desertdisability.com. Thank you.
Thank you for contacting Desert Disability
Based on your responses, the claimant may not be eligible for Social Security Disability Insurance ("SSDI"). However, the claimant may still be eligible for Supplemental Security Income ("SSI") benefits. Our firm does not handle SSI-only cases at this time, however, if we have a trusted referral source, we will send you an email with their information for further assistance.
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Has the claimant already filed for Social Security Disability?
No
Yes
What stage is the claimant's disability claim at?
Please Select
Initial application filed, waiting on decision.
Initial application denied, need to appeal
First appeal filed, waiting on decision
First appeal denied, need to request a hearing
Request for hearing filed, waiting for hearing
Denied by a judge at a hearing
Final appeal denied by Appeals Council
Approximately when did the claimant file their application for disability?
What is the date shown on the first page of the denial letter?
Please upload the most recent denial letter the claimant received.
Browse Files
Drag and drop files here
Choose a file
This is very helpful in the review of your disability claim
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What is the claimant's date of birth?
*
What is the claimant's marital status?
Please Select
Married
Single
Who does the claimant live with?
Does the claimant own and take care of any pets?
Please Select
Yes
No
Does the claimant drive a vehicle?
Please Select
Yes
Occasionally
Only when necessary
Not anymore
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Approximately when did the claimant last work?
*
What was the claimant's last job?
Why did the claimant's last job end?
If the claimant is still working, input "still working".
Describe the claimant's work history over the past 5 years.
*
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What is the claimant's highest level of education?
Please Select
High school or GED
Some college
College degree or trade school
Less than high school
Did the claimant serve in the military?
Please Select
Yes
No
Has or does the claimant receive any of the following benefits?
Early Retirement from Social Security
Short or Long Term Disability
Workers' Compensation Benefits
Unemployment Benefits
EBT or SNAP Benefits
AHCCCS Health Insurance or Medicaid
VA Benefits
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What are the claimant's diagnosed medical conditions?
*
What is the approximate number of medications the claimant has been prescribed?
Select any ambulatory devices the claimant has been prescribed.
Cane
Walker
Wheelchair
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List the types of doctors the claimant is currently seeing and for how long.
*
i.e., PCP for 2 years, Oncologist for 6 months, etc.
Is at least one doctor likely to support the claimant filing for disability?
Please Select
Yes, fully supportive
Most likely yes
Have not discussed disability with doctors
The claimant is not seeing any doctors
Unlikely to be supportive
Name of claimant's health insurance
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Does the claimant have any history of drug use or alcohol abuse?
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How does the claimant's medical conditions impact their ability to work?
*
Submit
Should be Empty: