DISABILITY PRE-SCREENING QUESTIONNAIRE
In order to best serve you, and know if you’re a good fit for submitting a claim, we need to collect the following information. Your accurate and thorough answers are needed to properly pre-screen your eligibility. Rest assured your information is strictly confidential and safe with us.
Note: this questionnaire is expected to take 20 minutes to complete. Be sure to hit “Submit” at the bottom of the form or we will not receive your information.
That’s it! Thank you for your information. We’ll be in touch soon.
