Request Appointment

Thank you for choosing Centra Rehabilitation.

Our locations offer flexible scheduling options for your convenience.

Please request an appointment online by completing and submitting the form below or contact us by phone, 434.200.7600, to set your preferred appointment time.

Once you have made your initial appointment, please complete our Patient Forms, which will save you time at your first visit.

This form is for Rehabilitation appointments only. Please use this form to request an appointment for physical therapy, occupational therapy or speech therapy.

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Preferred number

Email address

Date of birth

Patient status

New patient

Existing patient

Type of appointment

Follow up appointment

New problem

Brief description of the problem you are having

Location of problem

Are you currently receiving care for this problem?

Yes

Primary care physician's name

Insurance type

What Centra Rehabilitation location would you like to be treated at?