Disability Assistance, LLC

Office: (770) 995-6009
Toll Free: (866) 995-6009

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P.O. Box 490519
Lawrenceville, GA 30049

"Serving the disabled throughout the South"

Meet Trisha! - Click here

Click to navigate to the Meet Trisha page

Trisha Cardillo, ADR

Owner / Representative

Free Online Evaluation

Office Information

Office Hours: Monday - Friday 9am 6pm
Office Telephone: (770) 995-6009
Toll Free: (866) 995-6009
Email: info@ssdisabilityassistance.com
Fax: (770) 962-0250

Please complete the following form if you are in need of representation.

***The information you submit is for the use of Disability Assistance, LLC only and will not be given to third parties for any reason without your consent.

* First Name:

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* Last Name:

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* Primary Telephone:

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Cell Phone:

Email:

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* Street Address:

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* City:

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* State/Province:

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* Zip Code:

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* Date of Birth:

Please select a valid month.Please select a month. Please select a valid date. Please select a valid year.

* Education:
(High school, some college, BS, etc.)

This is required.

* All types of jobs worked in the last 15 years:
(construction, office, etc.)

This is required.

* Date Last Worked:

Please select a valid month.Please select a month. Please select a valid date.Please select a date. Please select a valid year.

Married:

Yes No

Spouse's Gross Monthly Income:

Number of dependent children (minor or disabled):

Benefits you are currently receiving:

	Worker's Compensation
	Long-Term Disability
	Food Stamps
	TANF (Welfare)

* Describe Impairments:

This is required.

Do you have a supporting doctor who is telling you that you should not be working?

Yes No

* Have you filed an application with Social Security?

Yes No Please make a selection.
If so, when? Please select a month. Please select a date. Please select a year.

* Have you received a denial?

Yes No
If so, when?

Please note: Social Security only gives you 60 Days to appeal a denied claim.. If you are approaching your 60-day deadline, you will need to file YOUR OWN appeal - I recommend in person, getting copies of every form you complete. At that point I can represent you.

Take advantage of our free online evaluation so that we can begin to help you today!

Click here

Download our printable
E-Brochure to have our information in hand for whenever you may need it.

Click here

We will apply all of our experience and resources, and do everything possible to win your disability claim as early as possible in the process. We will always return your calls and answer your questions with patience and understanding. We will treat you with the respect and dignity that you deserve. We will not charge you any fee, unless we win your case.

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