Fresno SCI-FIT Online Application

In an effort to provide the most safe and effective program, it is necessary for all clients to complete this application in its entirety. All information provided will remain confidential. If the client is under the age of 18, a parent or guardian must sign the application.


Yes

Cell number if no land line

In case of emergency, please notify:


MEDICAL INFORMATION



Length of stay:

Length of stay:


Please list all current medications:


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:


SENSORY AND MOTOR CONDITIONS


QUALIFICATIONS

All neurological disorders will be assessed on a case-by-case basis. The primary qualifications that must be met in order to become a client at SCI-FIT are the following:

  • The client must possess some level of cognitive function (intellectual process by which one becomes aware of, perceives, or comprehends ideas, and involving all aspects of perception, thinking, reasoning, and remembering).
  • Client must be cleared by a physician to participate in an intense exercise therapy program
  • Client must be cleared by a physician to perform weight-bearing activities through the upper and lower extremities (a bone scan will be required for those 1 or more years in a wheelchair or non-load bearing environment)
  • Client must possess a positive attitude and willingness to work hard