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Free patient intake form for physiotherapy clinics in United Arab Emirates
A physio clinic in the UAE needs a patient intake form that asks the right questions, shows prices in AED, uses +971 phone numbers and fits the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021). CalendarForm gives you that form free for 250 submissions a month, joined to a booking page that shows times in Asia/Dubai (UTC+4 all year, no daylight saving).
Make this form free See a demo booking page
What to put on a patient intake form in United Arab Emirates
- 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 +971 50 123 4567)
- Date of birth, written DD/MM/YYYY in the UAE
- Preferred language (Arabic 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 (Federal Decree-Law No. 45 of 2021))"
Show the price as text on the booking page, for example "AED 150 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 UAE.
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 United Arab Emirates, 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.
United Arab Emirates at a glance
| Time zone | Asia/Dubai: UTC+4 all year, no daylight saving |
|---|---|
| Currency | AED (AED), written like AED 150 |
| Phone format | +971 50 123 4567 |
| Date format | DD/MM/YYYY |
| Week | starts Monday; weekend is Saturday and Sunday |
| How customers pay | card, Apple Pay and cash |
| Languages to consider | Arabic and English |
| Privacy law | the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021) |
Privacy: what the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021) means for this form
Nationally, the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021) is the UAE federal data law: get consent and use details only for the booking you said they are for.
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 United Arab Emirates
United Arab Emirates has no daylight saving, so your timetable never shifts against UTC: UTC+4 every day of the year.
Customers booking from abroad still see the time in Asia/Dubai, 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/Dubai and add your opening hours.
- Edit the questions above, add the the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021) 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 United Arab Emirates?
- 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 AED.
- Does the form follow the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021)?
- The form collects only the questions you add and shows your consent line. Following the Personal Data Protection Law (Federal Decree-Law No. 45 of 2021) is still your job: ask only what you need, say why, and link your privacy notice.
- Can I write the form in Arabic?
- Yes. Questions, options and the thank-you message are free text, so you can write them in Arabic and English.
Related
- CalendarForm for physio and wellness clinics
- Online intake forms that come with the booking
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