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Applicant Information

Permanent Home Address

(with area code)

(with area code)

In case of emergency, please notify:

Medical Information

Spinal Cord Injury

Other Neurological Injury/Disorder

Hospitalization of Initial Trauma

Location of Rehabilitation

Please answer Yes or No to the following. Indicate "Yes" for those that apply to you at present or have applied to you in the past:

A physican's release is required to participate in Center for Neuro Recovery

Sensory and Motor Conditions

Please check if you understand this policy

Please check if you understand this policy


To become a client of Center for Neuro Recovery, one must meet the following criteria:

  • Provide medical clearance from their primary care physician
  • Provide a recent bone density scan with a letter of interpretation from a Florida based primary care physician
  • Complete an in person assessment of your current physical and cognitive capabilities and receive approval from our specialized staff and management to be deemed appropriate for our C.A.S.T. program
  • Commit to three to five days a week, for up to three hours each day, of activity-based, functional pattern movement exercise, muscle memory, stretching and range of motion

I have completed this application to the best of my knowledge in an effort to make known any medical conditions that may limit my participation in Center for Neuro Recovery. I further understand that Center for Neuro Recovery has the right to terminate my program at any time.