Free Assessment « Stromatt & Associates

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Disability Process
FAQS
Contact
Your Advocates

Home
Disability Process
FAQS
Contact
Your Advocates

Free Assessment

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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