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 … especially any denial letters and appeal forms.

Also helpful

2. Medical or hospital records in your possession.  You need not, however, make any special record requests of doctors or hospitals.

3. If you have been involved in any other disability cases (such as short or long-term disability or worker’s compensation), please bring any papers you have related to those cases.  Any unemployment compensation papers you have will also be useful.

4. A history of your employment over the last 15 years

Lists containing the following information can speed up the evaluation of your case

5. Prescriptions or medications used to treat your condition

6. Doctors you have seen, noting specialty if any

7. Restrictions or limitations your doctor has discussed with you

8. Dates of any attempts to return to work, with pay stubs if you have them

Bring what you can and don’t worry if you only have a few of these items.

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