Serrano Law Firm, LLC

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Connecticut Personal Injury & Accident Lawyer Blog

860 236-9350  ▪  800 856-6400

690 Flatbush Avenue, West Hartford, CT 06110-1308

27 Holmes Avenue, Waterbury, CT  203 756-6100

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690 Flatbush Avenue West Hartford, CT  06110-1308

860 236-9350             800 856-6400  toll free     860 523-9101  fax

27 Holmes Avenue Downtown Waterbury 203 756-6100

 

Social Security Disability Inquiry Form - Child

* Required

Child's Name*
Child's Soc. Sec. No.*
Child's Date of Birth*
Your Name*
Relationship to Child*

Phone Number(s)*
Address, City, State, Zip Code*
E-Mail*
Child's Grade

Is Child In Special Education?*

Child's School
School Address
School Telephone
Teacher's Name
At What Level Is Your Child's Case?*

Remember:  60-Day Deadline to Appeal Denied Cases

If The Hearing Is Scheduled, Tell Us:

Date:   

Time:   

Judge: 

Location:

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Where Did You File Your Child's Case?

        Massachusetts

 

Click Which Of These Conditions Your Child Has

Please Tell Us About Any Other Medical Problems Your Child Has

Click Which of These Hospitals Your Child Has Gone To

 

Massachusetts

 

Tell Us Your Child's Doctors

Include Name, Address, Telephone

Tell Us Your Child's Prescription Medications

 Please include the area codes for your phone number(s).

 

Please note that with this form you are only sending us information.

To hire us as your attorney you must sign a contract with us to represent you in this matter.

Thank you for sending us this information.

 

Attorney John Serrano - Personal Injury, Social Security Disability, Divorce, Bankruptcy, Immigration, Workers Compensation.  Hartford, Waterbury

Please note that our law firm's website is designed to provide only general legal information.

This information is not intended to be legal advice for your individual situation.

Call us for personal injury, Social Security, divorce, bankruptcy, immigration, workers compensation and criminal cases.

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