How To Apply

Printable Application


Payment Policies: Updated: April 1, 2014
Credit Card Information

Application- Spinal Cord Injury
Application- Multiple Sclerosis
Application- Brain Injury / Stroke
Physician's Clearance Form
Qualification Questionnaire
Required Bone Density Results
Waiver & Release From Liability























































Am I a potential client?

A potential client must be motivated to participate in our program. All clients must be independent of a ventilator. Applicants must also receive a written clearance from their physician. Lastly, clients will also need to supply Push to Walk with a current (within the last 6 months) report of a bone density test. Our program is very demanding on the muscles and skeletal system and it is important to ensure that everyone’s body is capable of withstanding the stresses that will be placed on their bodies. Clients must be able to maintain their appointments on a consistent basis, have reliable transportation and the financial ability to pay the hourly fee of $95.

Still not sure if you’re a candidate?

We contact you...
For someone to contact you about participation in Push to Walk’s program, please fill out the following contact form.

Important Note:
Prior to your initial evaluation, your physician’s clearance and bone density test report must be sent to Push to Walk either by fax or mail.