Dale Buchanan and Associates, P.C.

Social Security Disability Appeals | Disability Insurance
Long-Term Disability | Railroad Retirement

Over 25 years experience in disability law

Toll Free Number
800-945-4950

Chattanooga
   (423) 894-2552

Knoxville
   (865) 637-4662

Nashville
   (615) 254-3090

Murfreesboro
   (615) 893-3456

Social Security
Administration

Free Evaluation
Form

NOSSCR - National
   Organization of Social
   Security Claimants'
   Representatives

Fill out our no obligation evaluation form

First Name
Middle Initial
Last Name
Date of Birth :
Address :
City :
State :	Zip Code: 5 digit
Telephone Number :	- -
E-mail Address :
Have you been to our office before?:	YES NO
When did you become disabled? (Onset Date) :
Are you working? :	YES NO
What was the date you last worked? :
Have you applied for Social Security disability? :	YES NO
If Yes, when did you apply? :
Where did you file your disability claim?
At what level is your claim? :
Are you now or have you recently been under a doctor's care? :	YES NO
Tell us about your disability.
Would you like us to contact you about having us represent you? :	YES NO

Not certified as a civil trial specialist by the Tennessee Commission on Continuing Legal Education and Specialization. Certification as a social security specialist is not currently available in Tennessee.