Contact Us

Please call 800 795 2849 or complete the form that follows for a reply. If you would prefer us to contact you by phone, please specify this in your comments. Please DO NOT send your Social Security number by e-mail.

We regretfully cannot follow up on general information questions or a possible need for representation assistance outside of our service area (Southeast/Central Michigan and the Toledo Ohio Area). We also specialize in representation for those 18 or over only.

* = required fields.

First Name:	*
Last Name:	*
Street Address:
City:
State:
Zip Code:
E-mail Address:	*
Phone Number:	*
Your Age:

Help us help you by answering the following questionnaire:
Are you still working?
If not, when did you stop working?
Have you applied for disability benefits?	Yes No
If Yes, what was the outcome?
What date were you denied or appeal:
Did you or do you have a professional representative helping with your claim?	Yes No
Additional Comments:


#######################
### loaded from cache created: 3/11/2010 2:48:06 AM
### render time=1.05957
### uid= rdn2779563@disabilitymanagement.net
### ip = 38.107.191.89


powered by: Raiden Technologies Toolset
                   www.raiden.ws