Experience Adventure

Experience Adventure

We are changing lives - join us!
Name*

First NameLast Name
E-mail
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Where do you live?
City, State
Phone Number*

Area CodePhone Number
Please select all that apply

I have a neurologic condition (must have a neurologic diagnosis)I want to volunteerI am a healthcare professionalI am a fitness/exercise providerI want my business to partner with you
What Programs are you interested in? Select all that apply

Neurologic Physical TherapyAdventure GroupPEAK Fitness ProgramRock Climbing for Health ProgramPickleball WellnessHealth WorkshopsFES Independent CycleVacation with a PurposeSOAR Yearly EventYoung Neuro
What are you interested in volunteering for?

Fundraising EventsCommunity Program supportEquipment MaintenanceGraphic DesignGreeter/Welcome CommitteeAdministrative TasksSOAR Yearly event
STOP!

Are you ready to jump into Destination Rehab's physical therapy appointments?

Follow this link to our intake paperwork and we will give you a call to discuss the next steps:

Destination Rehab Patient Registration

If not please continue submitting this form
How did you hear about us?*
Tell us about yourself & what you would like from our program!*
What is the name of your insurance company?
Should be Empty: