Social Security Legal
(702) 382-2222   
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Contact
Contact Information
If you are disabled, cannot work, and think you may be entitled to government benefits, please fill out this form, and someone will contact you within two business days.  Or you can just call us at (702) 382-2222. Ask for Natalie. 
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Last date you worked:
Have you already applied for benefits?:
When did you last see a doctor?
What are your disabilities?:
Email:
Comments:

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