Free Disability Evaluation Form

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Case Details Name

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E-mail Address

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Address

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Phone Number

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Age

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Education

Current SSA Level

Employment History

Date of Last Day Worked

Yes, I have collected unemployment or been in jail since I last worked.

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Disabilities (list)

CD Issues

Surgeries (list)

Medications (list)

Physical Limitations (list)

Treating Physicians' Contact Information (list)

Doctors That Support the Client as Disabled

Emergency Contact - Name and Phone Number

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Free Social Security Disability Evaluation

Our attorneys and staff have compassion for the kinds of difficulties faced by our clients. We also understand that the legal issues and claims process can be frustrating and that this can add to the stress...

Midwest Disability TM | Chat now or leave a message

Jan 24 - Social Security Disability Under Review
Dec 30 - One Woman's Social Security Disability Journey
Nov 28 - Social Security Administration Announces 13 New Compassionate Allowance Conditions
Nov 14 - Bill Seeks to Remove Waiting Period for Terminally Ill SSD Applicants
Nov 04 - Social Security Recipients Get Benefit Increase

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Midwest Disability, P.A.
408 Northdale Boulevard Northwest
Coon Rapids, MN 55448
Coon Rapids Law Office

Telephone: 763-447-4103
Toll Free: 888-351-0427
Fax:763-862-7521

Midwest Disability, P.A.
5730 N Broadway Street
Kansas City, MO 64118
Kansas City Law Office

Telephone: 816-569-2018
Toll Free: 888-351-0427
Fax: 816-569-2017

Midwest Disability, P.A.
17 W. 220 22nd Street, Suite 320
Oakbrook Terrace, IL 60181
Oakbrook Terrace Law Office

Telephone: 630-559-3080
Toll Free: 888-351-0427
Fax: 630-559-3082

Midwest Disability, P.A., serves clients seeking disability benefits throughout Minnesota including the cities of Minneapolis, Saint Paul, Rochester, Duluth, Bloomington, Plymouth, Brooklyn Park, Eagan, Eden Prairie and West Coon Rapids.