Free Assessment

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Disability Process
FAQS
Contact
Your Advocates

Home
Disability Process
FAQS
Contact
Your Advocates

Fill out our online form so we can better understand your situation. We will give you a call to discuss your case in greater detail. Let Stromatt and Associates begin to help you today!

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Fields marked with an * are required

First Name *

Last Name *

Phone *

Email *

Address

Apt, Suite, Bld. (optional)

City

State

Zip / Post Code

Education *

Please select the highest level completed.

Date of Birth *

(mm/dd/yyyy)

Employment *

Please list all types of work done in the last 15 years. (construction, office, etc.)

Date Last Worked *

mm/dd/yyyy

Number of Dependents

Number of people that are income tax deductions

Married

Spouses Gross Monthly Income

Benefits You Are Currently Receiving

Worker's Compensation

How much per month?

Long-Term Disability

How much per month?

Food Stamps

How much per month?

Other

How much per month?

Describe Impairments *

Do you have a supporting doctor who is telling you that you should not be working?

Have you filed an application with Social Security? *

If So, when did you file with Social Security?

mm/dd/yyyy

Have you received a denial? *

If So, when were you denied?

mm/dd/yyyy

LOCATIONS:

Kentucky Office
1500 Leestown Road, Suite 140, Lexington, KY 40511
(877) 859-0246 Toll Free
(859) 246-0246 Local
michelleh@stromattandassociates.com

Free Assessment of Disability

Click the BEGIN HERE button to fill out our online form. This will enable us to better understand your situation, and we will give you a call to discuss your case in greater detail. Let Stromatt and Associates begin to help you today!

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