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Markhoff & Mittman, P.C. - 914.946.1452

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Do you have a possible case? Do you have any idea what type of case? Do you just need some answers? Feel free to fill out our contact form and a representative of Markhoff & Mittman will get back to you soon.

Main Office

14 Mamaroneck Avenue Suite 201
White Plains, NY 10601

Phone: 914.946.1452
Fax: 914.946.0810
Toll Free: 888.799.3918
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Long Island Office

1778 Hempstead Turnpike
East Meadow, NY 11554

Phone: (914) 946-1452
Fax: (914)946-0810
Toll Free: (888) 799-3918
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New York City

New York City
New York City, NY

by Appointment Only
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"So we can best help you, please read and answer all questions carefully."
Does the issue involve asbestos-related cancer (mesothelioma) or lung cancer? Yes No
Is this application for a child (Under 18)? Yes No
   
Applicants' Information  
* First Name
* Last Name
Address
* Zip Code
* Best phone number to reach you?
Best time to reach you at this number?
Another phone number to reach you?
Best time to reach you at this number?
* Email Address
What is applicants relationship to you
* Already receiving Social Security benefits? Yes No
* Date of birth (mm/dd/yyyy)
Is applicant?
* What health condition prevents Applicant from working?
* Has applicant been, or expect to be, out of full-time work for at least 12 months (earning LESS THAN $980.00 in payroll checks per month)? Yes No
When did the applicant stop working? (mm/dd/yyyy)
Have you worked at least five of the last ten years? Yes No
* Have you ever applied for Social Security Benefits? Yes No
If yes, when were you last denied? (mm/dd/yyyy)
Did you appeal? Yes No
If yes when? (mm/dd/yyyy)
Were you denied the appeal? Yes No
* Do you HAVE an attorney assisting you with this matter? Yes No
Studies show 90% of Social Security Claims are initially denied without the help of an attorney or qualified representative. We offer a NO COST consultation to help you get approved fast.
* Would you like an attorney or representative to call you at NO COST? Yes No
* Please provide a brief description of the situation:
* Are you a legal citizen of the United States? Yes No
* Are you currently a Markhoff & Mittman client? Yes No
   
* I understand that submitting this form does not create an attorney-client relationship.
   
 


New York AttorneyWestchester Attorney  | White Plains AttorneyBronx Lawyer  |
Workers' Comp Attorney New York  | Workers' Comp Attorney White Plains   |
Westchester Workers' Comp Attorney   | White Plains Social Security Disability Attorney
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New York AttorneyWestchester Attorney  | White Plains AttorneyBronx Lawyer  |
Workers' Comp Attorney New York  | Workers' Comp Attorney White Plains   |
Westchester Workers' Comp Attorney   | White Plains Social Security Disability Attorney
Legal Disclaimer 



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