Disability Benefits Evaluation Request
The form below contains eleven (11) parts. It will take at least twenty (20) minutes to complete. Depending on your unique situation, completing this form may be a lengthy process. The information requested in this form is the same kind of information we would request from you on your initial consultation to our office. Completing this form does not obligate you in any way, nor does it obligate our firm to represent you. This form is simply a tool for helping us evaluate your potential for acquiring disability benefits from the Social Security Administration.
Completing this Form
You will need some fair amount of information on hand to complete this form. You might find it easier to print our paper-based form and use it. If you would like to complete the questionnaire offline on paper, click on the print button below. If you have not already done so, call our office to schedule a consultation and be sure to bring the completed forms with you then.
Completing this form online does not replace a consultation with our attorneys. Consultations are cost and risk-free. Completing this form online will save you time at your initial consultation, and you will not have to provide this information again. The more thorough you are in responding, the fewer questions our paralegals will have to adequately prepare for your consultation with your attorney.
If you have not already contacted our office, we will use your preferred method of contact to setup your consultation.
~ What Our Clients Say ~
David Gantt and his staff were excellent very informative, kept me updated on every move and with this dedication I was able to win my Social Security hearing. Highly Recommend.
Amazing! When my husband was injured, we didn’t know who to turn to. I started googling to find a attorney, I called Mr. Gantt, I couldn’t be more thankful! The nightmare was over as Mr. Gantt and his amazing team handled everything from that very moment! Not only was professional but extremely caring, taking time…
David Gantt and his staff handled my disability claim and they were excellent. I highly recommend him, he is the best in Western North Carolina. Mrs. Kelly Reaves 5.0 stars November 5, 2019
David is clear, precise, and delivers as promises.
The entire staff were welcoming, knowledgeable, helpful, and nice people! David was professional. He knew exactly what he was talking about and did what he said he was going to do. I have had a wonderful experience with this firm and will not hesitate to use them in the future.
I was very satisfied with David Gantt’s expertise and knowledge in all aspects handling my case. He dealt with all the paperwork and contacted all necessary providers to get my medical history – it was extremely hassle free! He communicated and counseled me on what to expect – being very forthcoming (he’s a straight shooter)!…
I highly recommend Mr. Gantt. He is very kind and always professional. He prepared me for my disability hearing and calmed my nerves. Everything happened exactly as he said it would. I honestly do not think that I would have been approved for disability without his help. Also, his office staff were always ready to…
Mr. Gantt took good care of me. I will be forever grateful for him getting me the social security payments I need for a disability due to military service. He seems like a genuine compassionate good man. I highly recommend! ~C.M.
David and his entire staff are so nice and show compassion to everybody. He was there when I had any questions. David Gantt is the best attorney in his field, he goes above and beyond. I am extremely grateful to him and his staff. ~M.H.
Very nice and friendly service. They always answered any of my questions. Had a great experience working with them on my disability case. I highly recommend there services! After trying for 6 years and 2 unfavorable decisions, David and his team did a great job representing my case and won. I appreciate there time and…
The whole office is very respectful. Answered all my questions. So Glad they were there cause I had no clue after fighting for 2 years. Thank you guys soo much. ~K.H.
I am very grateful to David Gantt & his staff! They were wonderful and made the confusing process much easier to understand. I wish I had contacted them sooner. They were super to work with and such nice people! Thank you so much! ~K.S.
Mr. Gantt is a highly compassionate and professional lawyer. He worked hard for me to show my disabilities. Always pleasant and supportive, while being very much on top of his cases. I recommend David Gantt to anyone. Great Attorney! 5 Stars. ~ Dakota
Wonderful client services..very friendly and willing to go the extra mile to help clients. highly recommend him for anyone needing assistance for the Disability SSI. ~T.D.
I am so grateful to Mr. Gantt & his staff. They have been so professional and knowledgeable. They’ve answered all of my questions and made a very stressful situation, bearable. I would not hesitate to recommend Mr. Gantt. He is knowledgeable, professional & caring. ~J.H.
Linda Calloway Mundy David Gantt is an outstanding Lawyer. I highly recommend him. He was beside me all the way and I would like to thank him. ~Linda 5 Stars
David Gantt and his staff are very professional, upfront, honest and nice. They made me feel at ease discussing my case. They helped me with every step of the way towards my disability approval. I would recommend them to anyone. They kept me updated on everything. Just wish I had contacted them sooner. ~D.P.S.
When I applied for Social Security Disability I saw no reason that I would need a lawyer since my case seemed clear. It wasn’t until the second rejection that I realized that I had no idea how the system worked. A couple of local lawyers I had contacted suggested that I talked to David Gantt…
This office is fantastic. The staff is helpful and friendly. He is honest with you about the pros and cons of your case. He works hard to get a positive result. ~S.G.
5.0/5.0 in Social Security. David was very professional, pleasant and focused on me and my situation while I was in his office. He did not allow interruptions. His office staff was helpful and readily available when I had questions.