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Free patient intake form for physiotherapy clinics in Calgary
A physio clinic in Calgary, Alberta needs a patient intake form that asks the right questions, shows prices in CAD, uses +1 phone numbers and fits PIPEDA. CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in America/Edmonton (UTC−7, UTC−6 during daylight saving).
Make this form free See a demo booking page
What to put on a patient intake form in Calgary
- 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 +1 (416) 555-0123 or a Calgary landline like +1 (403) 555-0147
- Date of birth, written YYYY-MM-DD in Canada
- Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (Alberta's PIPA)"
Show the price as text on the booking page, for example "C$45 for a first assessment, pay by card and Interac debit". CalendarForm does not take payment itself, so customers pay you the way they already do in Canada.
What physiotherapy clinics usually let customers book
- Initial assessment: a 1-to-1 appointment, 60 min
- Follow-up: a 1-to-1 appointment, 30 min
- Sports massage: a 1-to-1 appointment, 45 min
For physiotherapy clinics in Calgary, CalendarForm gives a physio, chiropractor or small wellness clinic an appointment page with separate services for first assessments and follow-ups, plus a pre-visit form so the first session starts with the history already in hand.
Make the initial assessment longer than follow-ups.
Set minimum notice so you can prepare for new patients.
Do not collect information you do not need.
Calgary at a glance
| Time zone | America/Edmonton: UTC−7, UTC−6 during daylight saving |
|---|---|
| Currency | CAD ($), written like C$45 |
| Phone format | mobile +1 (416) 555-0123; Calgary landline +1 (403) 555-0147 |
| Date format | YYYY-MM-DD (DD/MM/YYYY and MM/DD/YYYY are also common) |
| Week | starts Sunday; weekend is Saturday and Sunday |
| How customers pay | card, Interac debit and Interac e-Transfer |
| Languages to consider | English |
| Privacy law | Alberta's PIPA (instead of PIPEDA for in-province businesses) |
Privacy: what Alberta's PIPA means for this form
In Alberta, Alberta's Personal Information Protection Act applies to private businesses in the province instead of PIPEDA.
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 Calgary
Calgary 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.
Calgary is on a different time zone from Toronto, so set your business time zone to America/Edmonton in CalendarForm settings.
Customers booking from abroad still see the time in America/Edmonton, 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 America/Edmonton and add your opening hours.
- Edit the questions above, add the Alberta's PIPA 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 Calgary?
- 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 CAD.
- Does the form follow PIPEDA?
- The form collects only the questions you add and shows your consent line. Following PIPEDA 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.
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