Apply to Join

Let's

Do This

How to Apply

We’re glad you’re interested in Push to Walk! Please review and complete one of the forms below.

Prior to your initial evaluation, your application and physician’s clearance must be sent to Push to Walk. Please send these by fax to 201-644-7568 or email them to schedule@pushtowalknj.org.

Application Form

Additional Documents

Please download or print the following documents and provide them to us before your evaluation.

Manual Application Form

If you’d like to complete the application by hand, please download the PDF or .doc file and return it to us.

Spinal Cord Injury

Multiple Sclerosis

Brain Injury/CP/Stroke/Other

Client Responsibilities

All clients must be independent of a ventilator. 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 $115. Scholarship funds are available to individuals who qualify.

Not sure?

Find out if Push to Walk is right for you.

If you’re not sure whether or not you’re a good candidate for Push to Walk, please complete the form below and a Push to Walk team member will get back to you to answer your questions.

* First Name

* Last Name

* Phone Number

* Email Address

* Address

* City

* State

* Zip Code

* Age

* Injury Date

* Injury or Diagnosis

* Height

* Weight

* Current Health Condition

* Secondary Health Complications

* Please explain any other health conditions.

How did you hear about us?

Schedule your tour today.

Push to Walk is a 501(c)3 organization and all donations are tax-deductible (EIN# 20-8059368).

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