Cardiology Intake Forms
Every cardiology intake form a heart practice uses, explained: what each one asks and why.
From the new patient form and symptom questionnaires to heart failure, heart rhythm, and procedure forms. Pick a form to see its questions.
Cardiology intake forms by area
Forms grouped by the area of cardiology that uses them. Every practice words its own forms differently; each page shows what a typical form asks.
- General cardiology 7
- Prevention and risk 4
- Coronary disease and rehab 4
- Heart failure 3
- Heart rhythm and devices 6
- Procedures and valves 5
- Pediatric cardiology 3
- Specialty heart clinics 4
General cardiology
7 forms- Cardiology follow-up questionnaire Coming soon
- Cardiology new patient form Coming soon
- Cardiology symptom questionnaire Coming soon
- Chest pain questionnaire cardiology Coming soon
- Palpitations questionnaire Coming soon
- Shortness of breath questionnaire Coming soon
- Syncope questionnaire Coming soon
Prevention and risk
4 forms- Hypertension clinic questionnaire Coming soon
- Lipid clinic new patient form Coming soon
- Preventive cardiology new patient form Coming soon
- Women's heart health questionnaire Coming soon
Coronary disease and rehab
4 forms- Cardiac rehab intake form Coming soon
- Coronary artery disease patient questionnaire Coming soon
- Duke Activity Status Index Coming soon
- Seattle Angina Questionnaire Coming soon
Heart failure
3 forms- Heart failure clinic new patient form Coming soon
- Heart failure follow-up questionnaire Coming soon
- KCCQ questionnaire Coming soon
Heart rhythm and devices
6 forms- AFEQT questionnaire Coming soon
- Anticoagulation clinic questionnaire Coming soon
- Atrial fibrillation questionnaire Coming soon
- Electrophysiology new patient form Coming soon
- Pacemaker clinic questionnaire Coming soon
- POTS questionnaire Coming soon
Procedures and valves
5 forms- Cardiac catheterization pre-procedure questionnaire Coming soon
- Heart valve clinic questionnaire Coming soon
- Post cardiac cath follow-up questionnaire Coming soon
- Preoperative cardiac evaluation form Coming soon
- TAVR evaluation questionnaire Coming soon
Pediatric cardiology
3 forms- Child chest pain cardiology questionnaire Coming soon
- Pediatric cardiology new patient form Coming soon
- Pediatric lipid clinic questionnaire Coming soon
Specialty heart clinics
4 forms- Adult congenital heart disease questionnaire Coming soon
- Cardio-oncology questionnaire Coming soon
- Inherited heart condition questionnaire Coming soon
- Pregnancy heart disease questionnaire Coming soon
Cardiology intake forms: FAQ
What intake forms does a cardiology practice use?
A new patient form and a medical history come first. Symptom questionnaires cover chest pain, palpitations, shortness of breath, and fainting. Clinics for heart failure, heart rhythm, and procedures add their own forms.
What does a cardiology new patient form ask?
Usually the reason for the referral, current symptoms, medications, allergies, and past heart tests and procedures. It also asks about risk factors such as blood pressure, cholesterol, diabetes, and smoking, and about heart disease in the family.
Which standard questionnaires do cardiologists use?
Some forms are validated scales. The Kansas City Cardiomyopathy Questionnaire has 23 items on how heart failure affects daily life. The Seattle Angina Questionnaire has 19 items on angina. The Duke Activity Status Index uses 12 questions to estimate functional capacity.
Why do heart patients fill in follow-up questionnaires?
Symptoms and daily function change over time. A short follow-up form shows the team what has changed since the last visit: new or worse symptoms, medication changes, side effects, and hospital stays.
Who fills in pediatric cardiology forms?
A parent or guardian answers for a young child. The forms ask about pregnancy and birth, growth and feeding, symptoms during exercise or play, and heart conditions in the family. Older children may answer some questions themselves.
How does AI Doctor help a cardiology practice?
AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language. It collects the answers for the cardiology team to review before the visit.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
