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Social Security Disability and SSI Applications and Appeals
Haase & Haase, Inc., P.C
Serving San Antonio, All South Texas & The Hill Country
San Antonio (210) 824-3239   Toll Free: 1-800-491-8666
Email: ssa-help@haaseonline.com
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The More Information You Can Provide Regarding Your Social Security Disability Case or SSI Appeal, The Better We Will Be Able To Assist Your Needs

Tell Us About Your Case

Personal Information:
First Name: Last Name: Age: Zip Code:
 
*If contacting us for someone else, please give the disabled person's information above and your name and relationship to the disabled person here.
Parent's Name:
Contact Information:
Telephone 1: Telephone 2: Email Address:
Work Information:
Are You Working? Date you last worked: Type of Work:
Yes No
Disability Information:
What Is Your Disability?   When Did You Become Disabled?
Disability Information:
Have You Applied for Social Security? If Yes, When Did You Apply?    
Yes No    
       
Have You Been Denied Yet? If Yes, When Were You Denied?    
Yes No
       

All information submitted will be treated in the strictest confidence.
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