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Free patient intake form for physiotherapy clinics in Ireland

A physio clinic in Ireland needs a patient intake form that asks the right questions, shows prices in EUR, uses +353 phone numbers and fits GDPR. CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in Europe/Dublin (UTC+0, UTC+1 during daylight saving).

Make this form free See a demo booking page

What to put on a patient intake form in Ireland

  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, in the local format (for example +353 87 123 4567)
  9. Date of birth, written DD/MM/YYYY in Ireland
  10. Preferred language (English and Irish)
  11. Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (GDPR)"

Show the price as text on the booking page, for example "€30 for a first assessment, pay by card and contactless". CalendarForm does not take payment itself, so customers pay you the way they already do in Ireland.

What physiotherapy clinics usually let customers book

For physiotherapy clinics in Ireland, 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.

Ireland at a glance

Time zoneEurope/Dublin: UTC+0, UTC+1 during daylight saving
CurrencyEUR (€), written like €30
Phone format+353 87 123 4567
Date formatDD/MM/YYYY
Weekstarts Monday; weekend is Saturday and Sunday
How customers paycard, contactless and Revolut
Languages to considerEnglish and Irish
Privacy lawGDPR

Privacy: what GDPR means for this form

Nationally, GDPR is the EU General Data Protection Regulation: collect only what you need, say why, and get clear consent for anything optional.

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 Ireland

Ireland 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 Europe/Dublin, 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 Europe/Dublin and add your opening hours.
  3. Edit the questions above, add the GDPR 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 Ireland?
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 EUR.
Does the form follow GDPR?
The form collects only the questions you add and shows your consent line. Following GDPR 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 Irish.

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