Complete our Social Security Disability Case Evaluation Form and a case manager or licensed attorney will review your claim and contact you via phone and or email.

You do not need to fill-out all fields, however, the more information you provide us, the better we can help you.

* - Indicates a Required Field

* Name

Street Address

Address Line 2

City

State

* Zip Code

* Email Address

* Daytime Phone

Date of Birth

-- mm/dd/yy

Educational Background

Case Type

Have you applied for disability?

Yes No

What was the date of the last denial notice that you received?

-- mm/dd/yy

When did your disability become so severe that you became unable to work?

-- mm/dd/yy

What Type of work have you done over the past 15 years?

Why do you believe you are disabled and not able to work at any type of job?

If this is a personal injury matter, please explain the nature of your case

 

Disclaimer text: TO BE PROVIDED

 

I have read and understand the disclaimer

 

  Please note that we will respond within 48 hours.

Joel Cunningham Jr. 
P.O. Box 459
120 Edmunds Blvd.
Halifax, VA 24558

Phone: (434) 476-6446
(800) 544-4262
Fax: (434) 476-6447
Email:

jc@joelcunninghamlaw.com
paula@joelcunninghamlaw.com
gloria@joelcunninghamlaw.com

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