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Free patient intake form for physiotherapy clinics in Auckland
A physio clinic in Auckland needs a patient intake form that asks the right questions, shows prices in NZD, uses +64 phone numbers and fits the Privacy Act 2020. CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in Pacific/Auckland (UTC+12, UTC+13 during daylight saving).
Make this form free See a demo booking page
What to put on a patient intake form in Auckland
- Full name
- What brings you in and when did it start?
- Pain level today (0–10)
- Current medication
- GP or referring doctor (optional)
- Consent to assessment
- Phone: mobile like +64 21 123 4567 or a Auckland landline like +64 9 xxx xxxx
- Date of birth, written DD/MM/YYYY in New Zealand
- Preferred language (English and Māori)
- Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (the Privacy Act 2020)"
Show the price as text on the booking page, for example "NZ$35 for a first assessment, pay by EFTPOS and card". CalendarForm does not take payment itself, so customers pay you the way they already do in New Zealand.
What physiotherapy clinics usually let customers book
- Initial assessment: a 1-to-1 appointment, 60 min
- Follow-up: a 1-to-1 appointment, 30 min
- Sports massage: a 1-to-1 appointment, 45 min
For physiotherapy clinics in Auckland, CalendarForm gives a physio, chiropractor or small wellness clinic an appointment page with separate services for first assessments and follow-ups, plus a pre-visit form so the first session starts with the history already in hand.
Make the initial assessment longer than follow-ups.
Set minimum notice so you can prepare for new patients.
Do not collect information you do not need.
Auckland at a glance
| Time zone | Pacific/Auckland: UTC+12, UTC+13 during daylight saving |
|---|---|
| Currency | NZD ($), written like NZ$35 |
| Phone format | mobile +64 21 123 4567; Auckland landline +64 9 xxx xxxx |
| Date format | DD/MM/YYYY |
| Week | starts Monday; weekend is Saturday and Sunday |
| How customers pay | EFTPOS, card and bank transfer |
| Languages to consider | English and Māori |
| Privacy law | the Privacy Act 2020 |
Privacy: what the Privacy Act 2020 means for this form
Nationally, the Privacy Act 2020 is collect only what you need for the booking and tell people what it is for.
This patient intake form asks about health, which most privacy laws treat as sensitive. Ask only what the clinician really needs and say why next to the question.
CalendarForm keeps each business's answers separate, lets you export them to CSV, and does not use them for anything else. Link your own privacy notice in the form's description.
Booking times in Auckland
Auckland changes its clocks for daylight saving, so a Initial assessment at 18:00 stays at 18:00 local time all year. CalendarForm skips times that do not exist on the night the clocks go forward.
Customers booking from abroad still see the time in Pacific/Auckland, with the zone printed next to it, and their confirmation email repeats it.
Set it up in four steps
- Sign up free, pick the closest business type, and rename the starter form to "Patient intake form".
- Set the time zone to Pacific/Auckland and add your opening hours.
- Edit the questions above, add the the Privacy Act 2020 consent line, and attach the form to your booking page.
- Share your link. Each booking sends an email confirmation with a cancel link, and a reminder 24 hours before.
Questions
- Is CalendarForm a medical records system?
- No. It handles booking and pre-visit forms. Keep clinical notes in your records system.
- Can patients reschedule?
- They cancel with the link in their email and book a new time.
- Is a free patient intake form enough for physiotherapy clinics in Auckland?
- For most small physiotherapy clinics, yes. You get 250 form submissions and 100 bookings free every month; after that, $5 buys 2,000 more submissions or 500 bookings, and packs never expire. Prices on your page can be in NZD.
- Does the form follow the Privacy Act 2020?
- The form collects only the questions you add and shows your consent line. Following the Privacy Act 2020 is still your job: ask only what you need, say why, and link your privacy notice.
- Can I write the form in English?
- Yes. Questions, options and the thank-you message are free text, so you can write them in English and Māori.
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- CalendarForm for physio and wellness clinics
- Online intake forms that come with the booking
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