ELLIS CLINIC · SSD APPOINTMENT BUILDER
ELLIS CLINIC · SOCIAL SECURITY DISABILITY

SSD Appointment Protocol Builder

Complete your information, list the conditions that make it difficult to work, review your records checklist, and create a filled copy of the Ellis Clinic Social Security Disability Appointment Protocol. Payment-card fields are intentionally left blank.

About You

This builder runs in your browser. Do not use a public/shared computer for sensitive information. The completed PDF should be handled like any document containing personal information.

Work Status & Representative

Conditions That Make It Difficult to Work

List the most disabling condition first. The original SSD protocol provides ten lines.

Records Checklist

Use this checklist to prepare the packet described in the supplied Ellis Clinic instructions.

Records: send copies only and send pertinent records rather than every page. Organize the sections with the most recent records on top. The generated PDF will include the supplied Instructions for Order of Records as page 2.

Review & Create PDF