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 Jakarta?

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 IDR.

Does the form follow the Personal Data Protection Law (UU PDP, Law No. 27 of 2022)?

The form collects only the questions you add and shows your consent line. Following the Personal Data Protection Law (UU PDP, Law No. 27 of 2022) is still your job: ask only what you need, say why, and link your privacy notice.

Can I write the form in Indonesian?

Yes. Questions, options and the thank-you message are free text, so you can write them in Indonesian and English.

Free forms › Indonesia › Jakarta

Free patient intake form for physiotherapy clinics in Jakarta

A physio clinic in Jakarta needs a patient intake form that asks the right questions, shows prices in IDR, uses +62 phone numbers and fits the Personal Data Protection Law (UU PDP, Law No. 27 of 2022). CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in Asia/Jakarta (UTC+7 all year, no daylight saving).

Make this form free See a demo booking page

What to put on a patient intake form in Jakarta

Full name
Email
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 +62 812-3456-7890 or a Jakarta landline like +62 21 xxxx xxxx
Date of birth, written DD/MM/YYYY in Indonesia
Preferred language (Indonesian and English)
Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (the Personal Data Protection Law (UU PDP, Law No. 27 of 2022))"

Show the price as text on the booking page, for example "Rp150.000 for a first assessment, pay by QRIS and GoPay". CalendarForm does not take payment itself, so customers pay you the way they already do in Indonesia.

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 Jakarta, 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.

Jakarta at a glance

Time zone	Asia/Jakarta: UTC+7 all year, no daylight saving
Currency	IDR (Rp), written like Rp150.000
Phone format	mobile +62 812-3456-7890; Jakarta landline +62 21 xxxx xxxx
Date format	DD/MM/YYYY
Week	starts Monday; weekend is Saturday and Sunday
How customers pay	QRIS, GoPay, OVO and bank transfer
Languages to consider	Indonesian and English
Privacy law	the Personal Data Protection Law (UU PDP, Law No. 27 of 2022)

Privacy: what the Personal Data Protection Law (UU PDP, Law No. 27 of 2022) means for this form

Nationally, the Personal Data Protection Law (UU PDP, Law No. 27 of 2022) is Indonesia's data law: ask for clear consent and collect only what the booking needs.

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 Jakarta

Jakarta has no daylight saving, so your timetable never shifts against UTC: UTC+7 every day of the year.

Customers booking from abroad still see the time in Asia/Jakarta, 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 Asia/Jakarta and add your opening hours.
Edit the questions above, add the the Personal Data Protection Law (UU PDP, Law No. 27 of 2022) 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 Jakarta?: 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 IDR.
Does the form follow the Personal Data Protection Law (UU PDP, Law No. 27 of 2022)?: The form collects only the questions you add and shows your consent line. Following the Personal Data Protection Law (UU PDP, Law No. 27 of 2022) is still your job: ask only what you need, say why, and link your privacy notice.
Can I write the form in Indonesian?: Yes. Questions, options and the thank-you message are free text, so you can write them in Indonesian and English.