Personal Injury

I represent disabled individuals. If your initial application for Social Security disability benefits has been denied or if your Request for Reconsideration has been denied, please answer the questions below if you would like me to review your case.

Asterisks(*) indicate required fields.

* NOTE * Please be sure to add reevesfirm.com to your address book or information could end up in your junk mail folder. Thank you!

*What is the date of your recent denial?

*Are you receiving any medical treatment?

*What stage of the Social Security process is your case currently?
 Haven't filed yet The Local Social Security office The Hearing Office (Waiting on a hearing date) The Appeal Council (A judge denied me and I appealed) I have an active case but I don't know where it is I don't know if I still have an active case

*Do you have an attorney representing you now?
 Yes No

*Are you working now?
 Full Time Part Time No

*What level of education have you completed?
 Elementary (6th) Middle (8th)  High school (12th)  College  Graduate School

*What was your most recent job?

*List the medical conditions that affect
your ability to work:
*1.

2.

3.

4.

5.

*Explain how these medical conditions keep you from working:

*Name:

*Date of Birth:

*Street Address:

*City, State, Zip:

*Email:

*Main Phone:

Alternate Phone:

*Best time for us to call:
 Morning Afternoon Evening

*Where did you hear about us?

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