Social Security Legal
(702) 382-2222  
 
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If you are disabled, cannot work, and think you may be entitled to Social Security Disability (SSDI) or Supplemental Security Income (SSI) benefits, please fill out this form, and someone from the Law Offices of Mitchell Posin, Chtd. will contact you within one business day.  Or you can just call us at (702) 382-2222
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Last date you worked:
Have you already applied for benefits?:
When did you last see a doctor?
What are your disabilities?:
Email:
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