Follow the steps to complete the intake sheet successfully.

1. Click the ‘Get Form’ button to access the TX Bailey & Galyen Social Security Intake Sheet. This will open the form in an interactive editor where you can input your information.
2. Begin by entering your full name in the designated fields: last name, first name, middle name, and maiden name if applicable. Also, provide your date of birth and indicate your sex.
3. Fill in your place of birth, including city, county, state, and country. This information helps verify your identity.
4. Input your Social Security number and driver's license number, along with the issuing state for the driver's license.
5. Provide your residential address including apartment number, city, county, state, and zip code. Include your contact information such as home phone, work phone, e-mail address, and cell phone number.
6. Indicate your marital status and provide your partner's name if applicable. This section is important for assessing your situation thoroughly.
7. You will need to answer questions regarding your disability application, including the dates you applied, became disabled, and last worked, along with your job title.
8. List any previous denials of benefits with relevant dates and indicate the current level of appeal your case is on.
9. Detail the highest grade you completed in school and any vocational training you have received.
10. Describe the types of work you have done in the last 15 years and any worker's compensation benefits you have received related to your disability.
11. Provide information on your impairments or diagnoses, along with the names of doctors treating you.
12. Answer yes or no to questions regarding accidents involving you or family members, serious injuries from drugs, and immigration matters needing legal assistance.
13. State the purpose of your visit today, and indicate whether you currently have a will.
14. Select how you were referred to Bailey & Galyen by circling the applicable option and providing the required information for specific sources.
15. Review your entries for accuracy and completeness. Once you are satisfied, you can save changes, download, print, or share the completed form.

Start filling out your document online today to ensure timely assistance with your Social Security needs.