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Denied Disability?

Consultative Examination (CE) Feedback Form

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Please fill-out the CE form

Your appointment with the Social Security doctor is over—now it’s our turn to review how it went. The SSA doctors are supposed to conduct fair, thorough exams, but unfortunately, they sometimes rush or omit critical details. Please take 3 minutes to fill out this form while the experience is fresh in your mind. Your answers will help David and your legal team prepare for your hearing.

Full Name(Required)

Date of Exam(Required)

MM slash DD slash YYYY

What time did the doctor actually sit down with you?(Required)

What time did the exam end?(Required)

What type of exam did you attend today?(Required)

Did the doctor physically touch or examine your problem areas?(Required)

Yes

Did the doctor measure your range of motion (e.g., using a tool to see how far you can bend your back, lift your arms, or turn your neck)?(Required)

Yes

Did the doctor ask you to perform physical tests? (Check all that applied)(Required)

Walk down the hall

Squat and stand back up

Bend over to touch your toes

Grip the doctor's hands/fingers

Stand on one leg

None of the above

Did you use a cane, walker, or brace during the exam?(Required)

Yes

Did the doctor ask if it was prescribed or how long you've used it?(Required)

Yes

Did the doctor administer any memory or mental testing? (Check all that applied)(Required)

Asking you to name the current President or the date

Asking you to count backward from 100 by 7s (or a similar math test)

Asking you to repeat a list of 3 words back to them later in the interview

Spelling a word backward (like W-O-R-L-D)

None of the above

Did the doctor ask about your daily struggles, anxiety, depression, or panic attacks?(Required)

Yes, extensively

Yes, but very briefly

No, they skipped it entirely

How would you describe the doctor's attitude toward you?(Required)

Polite and professional

Rushed/impatient

Dismissive or rude

Did the doctor ask you how your medical conditions prevent you from working a regular job?(Required)

Yes

Did the doctor make any comments that felt strange, dismissive, or unfair?(Required)

Yes

Please Explain Below(Required)

In your own words, please describe anything else you think David should know about this appointment (e.g., long wait times in the lobby, unhelpful staff, or if the doctor seemed to ignore your pain during a test)(Required)