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Are you living with a spinal cord injury or a spinal cord disability/birth defect? NAF's mission is to help with mobility equipment, home modifications, vehicle modifications and technology to ensure maximum independence and self-sufficiency for our clients.

We assist people in the following Texas counties: Bosque, Collin, Cooke, Dallas, Delta, Denton, Ellis, Erath, Fannin, Grayson, Henderson, Hill, Hood, Hunt, Jack, Johnson, Kaufman, Lubbock, Montague, Navarro, Palo Pinto, Parker, Rains, Rockwall, Somervell, Tarrant, Van Zandt and Wise.

Applications can be submitted at any time. Please complete the following application online and submit it to NAF. We will contact you after the application is received. Thank you for your interest in NAF.

Client Application Form:



Birthdate:




Primary Contact First Name:
Primary Contact Last Name:
Primary Contact Phone:
Primary Contact Email:
Patient has children at home:
Ages of children:
Describe spinal cord injury:
Type of assistance requested:
Describe patient's needs:
Patient Discharge Date:
Will patient be using catheters:
Is patient insured:
Does patient have Medicare/Medicaid:
Describe other program eligibility:
Patient is a veteran:
Social Worker First Name:
Social Worker Last Name:
Social Worker Phone:
Social Worker Email:
Person Submitting Application:
Person Submitting Application Email:
Person Submitting Application Phone: