Disability Screening Form

 

ElevatePFS helps individuals determine if they are potentially eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). If you or someone you know has been unable to work for 12 months or more because of a disabling condition, we may be able to help. Our initial consultation is at no cost to you – fill out the form below to begin the screening process.  

Disability Screening
Disabled Individual’s Name:
Disabled Individual’s Name:
First Name
Last Name
Referring Individual's Name
Referring Individual's Name
First
Last