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Have you ever applied for Social Security Disability/Supplemental Security?*

Yes

Are you currently receiving Social Security/SSI?*

Yes

Are you seeing doctors?*

Yes

Are you currently working?*

Yes

When did you last work?*

First Name*

Last Name*

Your Phone*

Email*

How old are you?*

Tell us What Happened*

Do we have permission to text your cell phone or email you?*

Yes

Compliance*

By checking this box and submitting this form, I am providing my express consent to Dr. Bill LaTour's Disability Advocates of America, directly or by third parties acting on its behalf, to deliver promotional, informational, and disability claim related messages via telephone calls and text messages made through use of automatic telephone dialing system, automated technology, SMS text messages (including messages generated by AI), prerecorded and/or artificial voice message, or AI generative voice to the telephone number I provided and to the SMS Terms of Use. I understand consent is not a condition of inquiry or legal representation. For SMS text messages, message & data rates may apply and message frequency varies. Reply HELP for help and STOP to cancel text messages. Visit our Privacy Policy for more information.

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