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Forms

New Patient and Intake Forms

 


 
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 at chptusa@gmail.com  or print out and bring with you to your first appointment. 

 

 

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 IntakeTo be completed by all new patients and returning 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
 

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

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

Take our Patient Satisfaction Survey!

 

 

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