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  • Have you seen a Doctor in the last 6 months?

  • Do you currently have a disability attorney or advocate?

  • Are you currently receiving any Social Security Benefits?

  • Are you currently working?

  • Have you worked for at least 5 of the last 10 years?

  • Are you prescribed Medication for your health issues?

  • Select Multi Options...
  • Briefly Describe Your Medical Condition

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