The LeadConsent certificate on every Axis lead

Form submitted

Oct 18, 2026, 4:30 PM EDT2026-10-18 20:30:07 UTC

Certificate issued

Oct 18, 2026, 4:30 PM EDT2026-10-18 20:30:11 UTC

Form created

Oct 14, 2026, 12:40 AM EDT2026-10-14 04:40:52 UTC

Lead came from

A paid ad

Times in Eastern Time, from the lead’s location.

Generated by LeadSwitchboard for legal leads from Meta’s records of Facebook lead 1290000000000000. It reconstructs the instant form as published, with the answers and consent choices Meta recorded. It is not a recording of the person’s screen, and Meta does not provide an IP address or device details for these leads.

Shared view. Campaign visibility settings apply to this view. The complete original is retained for agency admins. The hash above covers this shared view; the verification badge checks the stored original. Visibility changes can change this view.

What the form showed, screen by screen

1. 1Intro

   Take the 30-second quiz to see if your application qualifies

   You will only receive a call from one disability firm if your case qualifies. Take the quiz to find out.

2. 2Questions and answers

   We’ll use this information to call and text you.

   Select your location

   MichiganChoices offered (50)

   Select Your Age Range

   45-49Choices offered (5)65 & over56-6450-5545-49Under 45

   Are You Currently Receiving Social Security Disability Benefits?

   No - I was denied, want to appealChoices offered (4)

   In the last 10 years, how many years did you work?

   I worked less than 5 of the last 10 yearsChoices offered (4)

   How long has your condition affected your ability to work?

   I've been unable to work for more than 3 yearsChoices offered (5)

   Are you currently receiving medical treatment for your condition?

   Yes, I see a doctor regularly and have recordsChoices offered (4)

   Are you currently working with an attorney or law firm?

   I'm looking to switch attorneysChoices offered (4)

   Is there anything else you'd like to share with us?

   My back got worse after I was denied and I can't stand for long.

   First name

   Jordan

   Last name

   Example

   Email

   jordan.example@example.com

   Phone number

   +15550104821

3. 3Privacy and consent

   Check the box below

   By checking this box,

   I provide my electronic signature under the E-SIGN Act and my express written consent for Northstar Claim Help and the law firm or advocate my request is directed to to contact me at the phone number and email address I provided, regarding my inquiry by human or AI generated calls, texts (SMS), email-to-text, emails, automated calls, and prerecorded messages. This consent overrides any prior federal or state Do Not Call registration. Consent is not a condition of receiving any goods or services. Msg/data rates may apply. Msg frequency varies. Reply HELP for help, STOP to cancel.

   TickedRequiredStarted unticked

   Privacy policy: Visit Northstar Claim Help’s Privacy Policy

Meta identifiers

Facebook lead ID

1290000000000000

Page ID

100000000000001

Form ID

1300000000000002

Form name

Oct 14th

Ad ID

120200000000000003

Ad name

SSDI Appeal Video

Ad set ID

120200000000000004

Ad set name

New Leads Ad Set

Campaign ID

120200000000000005

Campaign name

SSDI

Platform

fb

To check this lead against Meta’s own records, an admin of the Facebook Page can find lead 1290000000000000 in Meta Business Suite Lead Center. This is a shared view, not the complete original record. Hidden answers are omitted before this page receives the data.