Fill out this short form for a
free claim evaluation.
Are you working now?

What was your most recent job?

Level of education?

Describe your impairment

How does it keep you from working?

Date of birth
City, state


Beth Alpert & Associates

53 W. Jackson
Chicago, IL 60604-3607
312-427-2611 phone
312-427-2644 fax

What to bring to our meeting

All of the following items will be helpful to assessing and developing your claim for Social Security disability benefits, but the initial items are most useful.

Most important

1. Any papers you have given to or received from the Social Security Administration regarding your disability claim

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