Palpitations Questionnaire
What a palpitations questionnaire asks, the areas it covers, and sample questions for practice staff.
The palpitations questionnaire on this page asks how a racing or irregular heartbeat feels, how long episodes last, and what else happens with them. The questions are a typical set built from UCLA's Cardiac Arrhythmia Center questionnaire and the Heart Rhythm Alliance atrial fibrillation checklist.
Palpitations questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a palpitations questionnaire 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 palpitations questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Do palpitations last longer than a few seconds?Episodes
- Does your heartbeat feel fast or irregular?Episodes
- Do they come in attacks or constantly?Pattern
- When did the palpitations first start?Pattern
- Do you get breathless during palpitations?Other symptoms
- Have you ever lost consciousness?Other symptoms
- Have you had an ablation or cardioversion?Heart history
- Do you have a pacemaker or defibrillator?Heart history
- Have you taken rhythm medicines in the past?Medications
- Do you take a blood thinner?Medications
- Did a close relative die suddenly?Family history
- Has a relative had early heart disease?Family history
These are examples to read, not a form to fill in.
Palpitations questionnaire: FAQ
What does a palpitations questionnaire ask?
The questions on this page follow the UCLA Cardiac Arrhythmia Center questionnaire and the Heart Rhythm Alliance checklist. They cover six areas: episodes, pattern, other symptoms, heart history, medications, and family history.
Who fills in a palpitations questionnaire, and when?
The patient, before the visit. The UCLA Cardiac Arrhythmia Center asks patients to bring its questionnaire to the first consultation.
Is it the same as an irregular heartbeat questionnaire?
Yes, both names describe questions about a racing or irregular heartbeat. An atrial fibrillation checklist goes further, asking about the diagnosis, rhythm medicines, and past tests.
Does the avatar decide whether palpitations are serious?
AI Doctor only asks the questions and records the answers. The practice's team reviews them and decides on the next step.
Is there a palpitations questionnaire template?
The Heart Rhythm Alliance publishes an atrial fibrillation checklist, and UCLA publishes its arrhythmia center questionnaire. The sample questions on this page show a typical set.
What happens after the form is completed?
The care team reviews the answers before the visit. The Heart Rhythm Alliance checklist also asks patients to bring any test results they keep at home.
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.
