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Free patient intake form for physiotherapy clinics in San Francisco

A physio clinic in San Francisco, California needs a patient intake form that asks the right questions, shows prices in USD, uses +1 phone numbers and fits state privacy laws (no single federal law). CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in America/Los Angeles (UTC−8, UTC−7 during daylight saving).

Make this form free See a demo booking page

What to put on a patient intake form in San Francisco

  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 +1 (212) 555-0123 or a San Francisco landline like +1 (415) 555-0147
  9. Date of birth, written MM/DD/YYYY in the US
  10. Preferred language (English, Spanish and Chinese)
  11. Consent: "I agree to the physio clinic using these details for my booking, as set out in the privacy notice (the CCPA / CPRA and state privacy laws (no single federal law))"

Show the price as text on the booking page, for example "$40 for a first assessment, pay by card and Apple Pay". CalendarForm does not take payment itself, so customers pay you the way they already do in the US.

What physiotherapy clinics usually let customers book

For physiotherapy clinics in San Francisco, 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.

San Francisco at a glance

Time zoneAmerica/Los Angeles: UTC−8, UTC−7 during daylight saving
CurrencyUSD ($), written like $40
Phone formatmobile +1 (212) 555-0123; San Francisco landline +1 (415) 555-0147
Date formatMM/DD/YYYY
Weekstarts Sunday; weekend is Saturday and Sunday
How customers paycard, Apple Pay, Venmo and Zelle
Languages to considerEnglish, Spanish and Chinese
Privacy lawthe CCPA / CPRA, plus state privacy laws (no single federal law)

Privacy: what the CCPA / CPRA means for this form

In California, California's privacy law gives customers the right to know and delete what you hold about them, for businesses above its size thresholds.

Nationally, state privacy laws (no single federal law) is there is no one national privacy law; several states, such as California, have their own, so keep the form short and explain why you ask each question.

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. Health providers covered by HIPAA have extra rules for patient information; a general booking form is not a HIPAA compliance tool.

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 San Francisco

San Francisco 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.

San Francisco is on a different time zone from New York, so set your business time zone to America/Los_Angeles in CalendarForm settings.

Customers booking from abroad still see the time in America/Los Angeles, 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 America/Los_Angeles and add your opening hours.
  3. Edit the questions above, add the the CCPA / CPRA and state privacy laws (no single federal law) 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 San Francisco?
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 USD.
Does the form follow state privacy laws (no single federal law)?
The form collects only the questions you add and shows your consent line. Following state privacy laws (no single federal law) 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 Spanish.

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