Schedule Request

Thank you for confiding in Rochester Therapy Center with your wellness pursuits. Please fill out the Shedule Request Form below; it only takes just a few minutes to complete.

Once submitted, our staff will review your request and will be in touch with you within
24 business hours.

General Information

Name
What type of therapy are you looking for?
Only if you are comfortable doing so, please share what issues we can help you with?

Morning (8am-10am), Midday (11am-2pm) Afternoon (3pm – 5pm)
**Midday Appointments typically have shorter wait times **

Payment Information

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Client Information

Address


Checkboxes

*For insurance coverage and costs, please contact your insurance company for details regarding your coverage. The contact numbet can be found on the back of your insurance card.