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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. 

PATIENT INTAKE

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
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

chptusa@gmail.com

 

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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