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Intake form templates for Indian clinics, with consent wording that reads like a person wrote it.

Three copy-ready intake forms: a general clinic form, a salon and spa form, and a wellness or nutrition form. Each one includes a plain-language data notice written with the DPDP Rules in mind, and a separate WhatsApp opt-in, because consent to treatment and consent to marketing are not the same thing.

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Before you copy

Three rules for a good intake form

  • Ask only what you'll use. Every extra field is data you must protect. If nobody reads the "occupation" field, delete it.
  • Separate the consents. One tick for "you may use my information to provide my care", a different, optional tick for "send me offers on WhatsApp". Under India's DPDP Rules, consent should be specific to its purpose, and WhatsApp's own Business policy requires opt-in before you message people.
  • Say it simply. A notice patients actually read beats a page of legal language. Name your business, say what you collect and why, and say how to withdraw.

Edit these for your services and check them with your adviser. They are starting points, not legal documents.

Template 1

General clinic intake form (physiotherapy, skin, hair, general practice)

  1. Full name
  2. Date of birth
  3. Gender (optional)
  4. Mobile number (with WhatsApp? yes / no)
  5. Email (optional)
  6. City and PIN code
  7. Emergency contact name and number
  8. Main reason for your visit
  9. How long have you had this concern?
  10. Current medicines
  11. Allergies (medicines, latex, others)
  12. Existing conditions (diabetes, blood pressure, thyroid, heart, other)
  13. Past surgeries or injuries relevant to this visit
  14. For women: are you pregnant or breastfeeding? (optional)
  15. How did you hear about us? (optional)
Your information. [Clinic name] collects the details on this form to register you, provide your consultation and treatment, keep your records, send appointment reminders and issue bills. Your information is seen only by our staff who need it and by service providers who store it for us. We keep records for as long as needed for your care and as the law requires. You can ask to see or correct your information, or withdraw this consent, by writing to [email] or messaging [number]. Withdrawing consent does not affect care already given.

☐ I agree to [Clinic name] using my information as described above.
☐ (Optional) Send me health tips and offers on WhatsApp. I can reply STOP at any time.

Template 2

Salon and spa client form

  1. Full name
  2. Mobile number (with WhatsApp? yes / no)
  3. Birthday (day and month only, optional)
  4. Services you're interested in
  5. Preferred stylist or therapist (optional)
  6. Skin or scalp sensitivities
  7. Allergies to products, fragrances or ingredients
  8. Recent chemical treatments (colour, keratin, peels) and when
  9. For massage: any injuries, pregnancy or areas to avoid
  10. Pressure preference (light / medium / firm)
  11. How did you hear about us? (optional)
Your information. [Salon name] uses these details to book and provide your services safely, keep your service history and preferences, manage packages or prepaid cards, and issue bills. Only our team and service providers who store data for us can see it. Ask us at [email] or [number] to see, correct or delete your details.

☐ I agree to [Salon name] using my information as described above.
☐ (Optional) Send me offers and birthday messages on WhatsApp. I can reply STOP at any time.

Template 3

Wellness and nutrition intake form

  1. Full name, age and mobile number
  2. Height and current weight
  3. Your main goal for this programme
  4. Typical day: wake time, meals, sleep time
  5. Diet type (vegetarian, eggetarian, non-vegetarian, vegan, Jain)
  6. Food allergies or intolerances
  7. Existing conditions and current medicines
  8. Recent lab reports (upload, optional)
  9. Physical activity per week
  10. Water intake per day
  11. Preferred consultation mode (in person / video)
Your information. [Practice name] uses this information, including any health details and reports you share, to assess you, plan and review your programme, schedule consultations and issue bills. Please don't send reports by chat; upload them here. Only your consultant and staff who need it can see your information. Write to [email] to access, correct or delete it, or to withdraw consent.

☐ I agree to [Practice name] using my information as described above.
☐ (Optional) Send me reminders and programme updates on WhatsApp. I can reply STOP at any time.

Notes

Why these forms are worded this way

  • Plain-language notice. The DPDP Rules, 2025 (Rule 3) expect a notice that stands on its own, in clear language, listing the data and purposes and how to withdraw consent. Most of these obligations come into force around May 2027; see the DPDP guide for clinics.
  • Separate WhatsApp opt-in. Meta requires businesses to get opt-in before messaging people on WhatsApp and to make clear the person is opting in to messages from that business. A separate tick keeps your broadcast list clean.
  • Birthday without year. Day and month are enough for a birthday message, and collecting less is safer.
  • No reports by chat. Health documents sent on WhatsApp end up on staff phones. Ask for uploads instead.

Use them in JBMOnboard360

Build any of these in the drag-and-drop forms builder, then share it as a link or print the QR code for your reception desk. Answers save to the client's record, and consent checkboxes are stored with the submission. Add e-signature where you need a signed consent for a procedure. Pricing is ₹1,999 per user per month billed annually plus 18% GST, with a 7-day free trial.

Questions

Intake form questions

Do I need a consent checkbox on my intake form?

Where you rely on consent to process personal data, the DPDP Rules expect a clear notice and a clear affirmative action, such as a tick. Keep marketing consent as a separate, optional tick.

Can I collect intake forms by QR code?

Yes. In JBMOnboard360 each form has a public link and a QR code you can print for the reception desk, and answers save to the client record.

Should I ask for Aadhaar on an intake form?

Generally no. Collect only what you need. If you have a specific legal reason to collect identity documents, take advice on how to store them.

Are these templates legally compliant?

They are starting points written with the DPDP Rules in mind, not legal documents. Adapt them to your services and have your adviser review them.

Keep reading

Related pages

DPDP Act for clinicsTimeline, obligations and a checklist. WhatsApp remindersOpt-in, templates and costs. Online bookingBooking page with approval.

Sources: Storyboard18 on the DPDP Rules, 2025; Meta: getting opt-in for WhatsApp. Checked October 2026. Templates are free to copy and adapt. Not legal advice.

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