Free Case Evaluation | Crossroads Disability

Name:

Age

Phone:

Do you have a physical or mental health condition that prevents you from working full-time?

Has your condition lasted, or is it expected to last, at least 12 months or result in death?

Are you currently working more than part-time or earning over $1,500/month gross?

Have you had medical treatment for your condition(s)?

Do you have regular doctors or specialists treating you right now?

Do you already have an attorney?

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I understand this form is not legal advice and submitting it does not create an attorney-client relationship.