Cardiac Rehab Intake Form
What a cardiac rehab intake form asks, why each part matters, and how rehab programs collect it.
A cardiac rehab intake form records the heart event or procedure that led to rehab, past tests, medicines, health habits, activity level, and goals. It's also called a cardiac rehab patient history or a phase II cardiac rehab assessment.
Cardiac rehab intake form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a cardiac rehab intake form in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample cardiac rehab intake form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What heart event or procedure led to rehab?Heart history
- Which heart procedures have you had, and when?Heart history
- Have you had a stress test?Tests
- When was your last echocardiogram?Tests
- Which medicines do you take now?Medications
- Do you have any drug allergies?Medications
- Do you use tobacco, or did you quit?Health habits
- Do you follow a special diet?Health habits
- What exercise do you do now, and how often?Activity
- Do you use a cane or walker?Activity
- What do you want to achieve in rehab?Goals
- Do you have a weight goal?Goals
These are examples to read, not a form to fill in.
Cardiac rehab intake form: FAQ
What does a cardiac rehab intake form ask?
The questions on this page follow the Summerlin Hospital and Allina Health cardiac rehab forms. They cover six areas: heart history, tests, medications, health habits, activity, and goals.
Who fills in a cardiac rehab intake form, and when?
The patient, at the start of a cardiac rehab program. The Allina Health form is an initial assessment, with a separate section for staff to record vital signs.
Is it the same as a cardiac rehab patient history?
Summerlin Hospital uses both names: its file is a cardiac rehabilitation patient history, and the form is headed cardiac rehabilitation intake form.
Does the form ask about mood and stress?
The Allina Health form asks about stress level and includes depression questions. The rehab team reviews those answers and decides on any next step.
Is there a cardiac rehab intake form template?
The sample questions on this page show a typical set, based on the Summerlin Hospital and Allina Health forms.
What happens after the form is completed?
The rehab team reviews the answers at the initial assessment, where staff also record vital signs.
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.
