New Patient Intake Forms


Please complete the following form:


All New patients or patients returning 90 days or more since your last session please click on the patient intake link and complete and email back to us or print out and bring with you to your first appointment. 


Be sure to include your email address on first form in packet.   Email: CHPTUSA@GMAIL.COM


Next click on the Box 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.

Patient Intake
To be completed by
all new patients

Shoulder, Arm, Hand Hip Foot, Ankle
Lower Back

Upper back



Physical Therapy, PC

1328 University Ave

Rochester NY 14607-1622
phone: 585-482-5060
fax: 585-482-7982


Monday 8:00 am - 6:00 pm
Tuesday 8:00 am - 6:00 pm
Wednesday 8:00 am - 6:00 pm
Thursday 8:00 am - 6:00 pm
Friday 8:15 am - 5:00 pm
Saturday Closed
Sunday Closed


CHPT is accepting new patients!

New Patient Information Here

Remember, you can decide which PT clinic is best for you!


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