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Free patient intake form for physiotherapy clinics in Cape Town

A physio clinic in Cape Town, Western Cape needs a patient intake form that asks the right questions, shows prices in ZAR, uses +27 phone numbers and fits POPIA. CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in Africa/Johannesburg (UTC+2 all year, no daylight saving).

Make this form free See a demo booking page

What to put on a patient intake form in Cape Town

  1. Full name
  2. Email
  3. What brings you in and when did it start?
  4. Pain level today (0–10)
  5. Current medication
  6. GP or referring doctor (optional)
  7. Consent to assessment
  8. Phone: mobile like +27 82 123 4567 or a Cape Town landline like +27 21 xxx xxxx
  9. Date of birth, written YYYY/MM/DD or DD/MM/YYYY in South Africa
  10. Preferred language (English, Afrikaans and isiXhosa)
  11. Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (POPIA)"

Show the price as text on the booking page, for example "R250 for a first assessment, pay by card and EFT". CalendarForm does not take payment itself, so customers pay you the way they already do in South Africa.

What physiotherapy clinics usually let customers book

For physiotherapy clinics in Cape Town, 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.

Cape Town at a glance

Time zoneAfrica/Johannesburg: UTC+2 all year, no daylight saving
CurrencyZAR (R), written like R250
Phone formatmobile +27 82 123 4567; Cape Town landline +27 21 xxx xxxx
Date formatYYYY/MM/DD or DD/MM/YYYY
Weekstarts Monday; weekend is Saturday and Sunday
How customers paycard, EFT, SnapScan and Zapper
Languages to considerEnglish, Afrikaans and isiXhosa
Privacy lawPOPIA

Privacy: what POPIA means for this form

Nationally, POPIA is the Protection of Personal Information Act: collect for a specific reason, tell people, and keep it safe.

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 Cape Town

Cape Town has no daylight saving, so your timetable never shifts against UTC: UTC+2 every day of the year.

Customers booking from abroad still see the time in Africa/Johannesburg, with the zone printed next to it, and their confirmation email repeats it.

Set it up in four steps

  1. Sign up free, pick the closest business type, and rename the starter form to "Patient intake form".
  2. Set the time zone to Africa/Johannesburg and add your opening hours.
  3. Edit the questions above, add the POPIA consent line, and attach the form to your booking page.
  4. 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 Cape Town?
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 ZAR.
Does the form follow POPIA?
The form collects only the questions you add and shows your consent line. Following POPIA 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 Afrikaans.

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