How to Apply
Am I a potential client?
A potential client must be motivated to participate in our program and is looking for a next step in continuum of care after physical therapy. All clients must be independent of a ventilator. Applicants must also receive a written clearance from their physician. Lastly, clients need to supply Push to Walk with a current (within the last six 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 is capable of withstanding the stresses that will be placed on their bodies.
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 firstname.lastname@example.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)
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.
Still not sure if you’re a candidate?
Please complete the form below, and a Push to Walk team member will get back to you.