Jump to Navigation

Social Security Disability Contact Form

If you are disabled and unable to work, you may be eligible for Social Security Disability benefits. For answers to your questions about Social Security Disability, contact our firm to schedule a consultation with an experienced attorney.

Do you need to speak with an Alabama Social Security disability lawyer? For a free consultation, contact Pitts & Zanaty, L.L.C.

Our firm has helped thousands of clients seek and receive Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). We also assist clients with disabled children who need SSI and Medicaid benefits. For additional information about Social Security Disability please see the articles below.

Thank you for contacting Pitts & Zanaty, L.L.C. Your message has been sent.

Call us now

or use the form below.

Social Security Disability Contact Form

Personal Information

*First Name

*Last Name

Maiden name

Other names used

*Email Address

*Phone Number

*Zip

Street Address

Apt/Ste

Incident Street Address

Incident Apt/Ste

*Incident Zip

Business phone

Cell phone

Please describe all of your injuries, illnesses, symptoms, and disabilities, whether physical, mental, or emotional.

How do your medical problems limit your daily activities?

Are you able to work?
Yes No

Are/were you self-employed?
Yes No

What is your age?

What is the last grade you completed in school?

Do you have a high school diploma or its equivalent?
Yes No

Do you attend a vocational school or college or program?
Yes No

If so, what did you study and did you earn any certifications or licenses?

Did you attend college?
Yes No

If so, what did you study and did you earn any degrees?

Please describe any graduate study or advanced or professional degrees.

Do you possess any vocational or professional licenses?

Approximately how long have you been in the workforce? (years)

Describe briefly the types of work you have performed.

If you are able to work, how many hours can you work per week?

Have you filed for disability benefits for the medical problem/s described above?
Yes No

Have you been turned down for benefit payments based on the medical problem/s described above?
Yes No

Have you appealed a Social Security decision that denied you benefits for the medical problem/s described above?
Yes No

Other information or concerns?

Copyright © 2017 FindLaw, a Thomson Reuters business

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

Back to Main

Office Locations

821 Quintard Avenue
Anniston, AL 36201
Phone: 256-238-0115
Toll Free: 800.295.1934

Medical Forum Building
950 22nd Street North
Suite 760
Birmingham, AL 35203
Phone: 205.254.1657

Click Here to View Our Other Offices