Feel free to complete the following Disability Questionnaire. DACR will review the information. If we are able to assist, we will contact you.
Full Name*:
Date of Birth*:
Address1*:
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Currently Working?:YesNoNa
Date You Last Worked:
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When did you become disabled? (Onset Date)*:
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At what stage is your claim?:Don't KnowInitial ApplicationReconsiderationHearingAppeals CouncilFederal Court
Are you currently under the care of a doctor?*:YesNo
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