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Claim Evaluation

Advocate Pathway Solutions logo representing trusted Social Security Disability advocacy

Navigating the Social Security Disability process can feel overwhelming, but you don’t have to face it alone. By completing the claim evaluation form below, you’re taking an important step toward receiving the support and benefits you deserve.


Our team is here to evaluate your case with care and expertise. Once we review your information, we’ll reach out to discuss the next steps and how we can best assist you on your journey to securing your benefits.

Personal Information

Date of Birth:
Month
Day
Year
Multi-line address

Current Work and Income

Are you currently working?
Yes
No
Have you applied for SSDI/SSI benefits before?
Yes
No
If yes, Date applied:
Month
Day
Year

Medical Information

Date the condition started affecting your ability to work:
Month
Day
Year
Are you currently receiving treatment?
Yes
No
Do you have medical records documenting your condition?
Yes
No

Functional Limitations

Can you perform tasks such as lifting, standing, or walking?
Yes
No
Do you need assistance with personal care or daily living?
Yes
No

Vocational Information

Have you received vocational training?
Yes
No

List your last three jobs and approximate dates of employment:

Additional Information

Do you have any dependents?
Yes
No
Have you been convicted of a felony?
Yes
No
Are you a veteran?
Yes
No
If yes, Date of service:
Month
Day
Year

Legal and Representation History

Have you worked with a disability attorney or representative before?
Yes
No
Do you have a current representative for your SSDI/SSI case?
Yes
No

Supporting Documentation

Do you have any of the following documents?

Medical records
Yes
No
Pay stubs or proof of income
Yes
No
Prior SSDI/SSI application/denial letters
Yes
No
Work history documentation
Yes
No

Acknowledgment

By signing this form, I certify that the information provided is true and correct to the best of my knowledge.

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Date
Month
Day
Year

If you think you are eligible or not eligible for disability, click on one of the links for more information about each program:

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