Free patient intake form for physiotherapy clinics in Philippines
A physio clinic in the Philippines needs a patient intake form that asks the right questions, shows prices in PHP, uses +63 phone numbers and fits the Data Privacy Act of 2012. CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in Asia/Manila (UTC+8 all year, no daylight saving).
Make this form free See a demo booking page
What to put on a patient intake form in Philippines
- 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, in the local format (for example +63 917 123 4567)
- Date of birth, written MM/DD/YYYY in the Philippines
- Preferred language (Filipino and English)
- Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (the Data Privacy Act of 2012)"
Show the price as text on the booking page, for example "₱500 for a first assessment, pay by GCash and Maya". CalendarForm does not take payment itself, so customers pay you the way they already do in the Philippines.
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 Philippines, 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.
Philippines at a glance
| Time zone | Asia/Manila: UTC+8 all year, no daylight saving |
|---|---|
| Currency | PHP (₱), written like ₱500 |
| Phone format | +63 917 123 4567 |
| Date format | MM/DD/YYYY |
| Week | starts Sunday; weekend is Saturday and Sunday |
| How customers pay | GCash, Maya, bank transfer and card |
| Languages to consider | Filipino and English |
| Privacy law | the Data Privacy Act of 2012 |
Privacy: what the Data Privacy Act of 2012 means for this form
Nationally, the Data Privacy Act of 2012 is Republic Act 10173: tell people what you collect and why, and get consent before you use it for anything else.
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 Philippines
Philippines has no daylight saving, so your timetable never shifts against UTC: UTC+8 every day of the year.
Customers booking from abroad still see the time in Asia/Manila, 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/Manila and add your opening hours.
- Edit the questions above, add the the Data Privacy Act of 2012 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 Philippines?
- 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 PHP.
- Does the form follow the Data Privacy Act of 2012?
- The form collects only the questions you add and shows your consent line. Following the Data Privacy Act of 2012 is still your job: ask only what you need, say why, and link your privacy notice.
- Can I write the form in Filipino?
- Yes. Questions, options and the thank-you message are free text, so you can write them in Filipino and English.
Related
- CalendarForm for physio and wellness clinics
- Online intake forms that come with the booking
- All free forms in Philippines
- Free patient intake form for physiotherapy clinics in Manila
- Free patient intake form for physiotherapy clinics in Cebu City
- Free patient intake form for physiotherapy clinics in Davao City
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