Disability Analysis
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Requirements for Eligibility

  • You are under age 65.
  • Have a medical condition expected to last at least 12 months.
  • Have medical evidence to substantiate your condition.
  • If you meet these requirements please fill out and then submit our screening form.


*First Name:
*Last Name:
Street Address:
Address (2nd):
City:
State/Province:
Zip Code:
Best Time to Call:
Work Phone:
*Home Phone:
*E-mail:
Date Last Worked:
Are you currently receiving SSA benefits or Railroad disability benefits?
If you answered "yes", what kind?
Do you have a disability application pending with Social Security?
IF you answered "yes", please list medical problems:
Date of Birth:
##/##/##  
Title of previous/last job :




Thank You!
*This field is required.

 

Disability Analysis
4204 Woodcock Drive, Suite 286
San Antonio, TX. 78228
Phone: 210-732-9551
Toll Free: 800-210-8166
Fax: 210-732-9554
cowand@disabilityanalysis.com

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The Disability Analysis web pages are intended to provide general information on selected topics as a public service. The information is intended - but not promised or guaranteed - to be correct or current. It does not contain legal or medical advice. The information is provided solely for informative purposes and does not create a professional relationship. Each individual situation is different and unique. The information contained in these web pages should not be relied on as applicable to you. Competent representation should always be consulted to advise on any Social Security Disability matter. Internet links on this site allows you to "jump" instantly to other on-line resources. Disability Analysis does not intend links to other web pages and their owners to be considered referrals or endorsements of the linked entities. We will gladly remove any link from this site upon request from the linked entity. This web site is not sponsored or associated with any particular linked entity unless specifically stated. The existence of any particular link is simply intended to imply potential interest to the reader.

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Disability Analysis
4204 Woodcock Drive, Suite 286, San Antonio, TX 78228

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