Application and Required Forms
Prior to your initial evaluation, your application, physician’s clearance, and bone density test report must be sent to Push to Walk either by fax (201-644-7568) or email kwolfe@pushtowalknj.org

Potential clients please review and complete one of the forms below.

• Spinal Cord Injury Application (PDF Format)
• Spinal Cord Injury Application (Word Document Format)
• Multiple Sclerosis Application (PDF Format)
• Multiple Sclerosis Application (Word Document Format)
• Brain Injury/Cerebral Palsy/Stroke/Other Application (PDF Format)
• Brain Injury/Cerebral Palsy/Stroke/Other Application (Word Document Format)

**All clients must be independent of a ventilator.**

Client Responsibilities
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 $105. Scholarship funds are available to individuals who qualify.