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SSA Intake Form

Fill out this form. We will get you ready for ID.me and the online application. When you are done, get all of your papers ready. When you click Submit, your form goes straight to Jessica. You do not need to email anything back.

About You

Full name *

Date of birth *

Phone *

Email *

City & State

Best way to reach you

Who told you about us?

Who Is This For?

This intake is: For me For my child (under 18) For my adult child (18–26) For another family member

If not for you — their full name

Their date of birth

Your relationship to them

Your SSA Situation

Who is the claim for? *

Have you applied for SSI or SSDI before? * Yes No Not sure

If yes, what happened?

Health conditions involved (for you or your child): *

When did the condition start? *

Doctors, clinics, or hospitals treating you (names and cities): *

Medications taken for the condition (names and doses): *

For a child: do you have school records we can review together? * Yes No Not a child claim

For an adult: when did you last work?

For an adult: jobs held in the last 15 years:

Do you have a my Social Security account online? * Yes No Not sure

What is your biggest concern right now? *

Which package are you interested in?

What to Have Ready

Have these nearby for your consultation: photo ID, Social Security card, any letters from SSA, medication list, and school or medical records for the claim.

How to get your full Social Security earnings record: sign in at ssa.gov to your my Social Security account, choose “Review your full earnings record now,” and save or print it. Only you can access your account — never share your password or codes with anyone, including us.

* I understand the information above is correct.

Your answers go straight to Jessica at Southern Oak Financial & Wellness. We do not sell or share your information.

Southern Oak Financial & Wellness

Email: southernoakfw@gmail.com
Website: Southernoakfw.org
San Antonio, TX — Serving San Antonio, the Rio Grande Valley & surrounding cities

DISCLAIMER: We do not provide refunds for services; there is NO guarantee of approvals, and we are not legal attorneys.