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Forms

New PatientNew Patient Forms

New Patient and Intake Forms

 

 
All new patients or patients returning 90 days or more since your last session please fill out the forms under the two sections below and email back to us at chptusa@gmail.com, or print out and bring with you to your first appointment. Thanks!

 

  1. New Patient Intake Forms
  2. Next click on the Box below that pertains to the reason of your visit. (This will give you a functional test form to fill out. Bring this with you as well.)
Please pick one: Shoulder, Arm, Hand Hip Foot, Ankle
Knee
Lower Back

Neck/Upper back

  

Lymphedema
Callan-Harris
Physical Therapy, PC
1328 University Ave
Rochester NY 14607-1622

phone: 585-482-5060
Fax:     585-482-7982
 

CHPT Facebook

 

Monday 8:30 am - 5:30 pm
Tuesday 9 am - 5:30 pm
Wednesday 9 am - 5:30 pm
Thursday 9 am - 5:30 pm
Friday 8:30 am - 5 pm
Saturday Closed
Sunday Closed
   

 

CHPT is accepting new patients!

New Patient Information Here

New Patient Form

Patient Forms

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Take our Patient Satisfaction Survey!

 

 

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