Schedule a Free Consultation Disability Assist440-490-3884outreach.disabilityassist@gmail.com Name * First Name Last Name Phone * (###) ### #### Email Who are you interested in applying for? * Myself My child Someone else Has this person applied for SSDI or SSI in the last 12 months? * Yes No The best way(s) to contact me are * Phone (AM) Phone (PM) Text Email Additional Message (Optional) Thank you! Please allow us up to 3 business days to contact you regarding your request.
