Chiropractic Health Questionnaire
What a chiropractic health questionnaire asks, the areas it covers, and sample questions for practice staff.
A chiropractic health questionnaire records an adult patient's reason for the visit, past tests, lifestyle, health conditions, and medications before the first visit. It's also called an adult health questionnaire.
Chiropractic health questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a chiropractic health 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 chiropractic health questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is the reason for your visit?Current problem
- Have you been treated for this problem before?Current problem
- When was your last spinal x-ray?Tests, imaging
- Have you had an MRI or CT scan?Tests, imaging
- How many hours a week do you exercise?Lifestyle
- Do you smoke, or did you before?Lifestyle
- Do you sleep on your back, side, or stomach?Sleep setup
- What kind of pillow do you use?Sleep setup
- Do you have high blood pressure?Conditions
- Does anyone in your family have diabetes?Conditions
- Which medications and supplements do you take?Medications
- Do you have any allergies?Medications
These are examples to read, not a form to fill in.
Chiropractic health questionnaire: FAQ
What does a chiropractic health questionnaire ask?
The sample questions on this page are based on the Shorewood Family Chiropractic health questionnaire. This page groups them into six areas: current problem, tests and imaging, lifestyle, sleep setup, conditions, and medications.
Who fills in a chiropractic health questionnaire, and when?
Adult patients, before the first visit. Shorewood Family Chiropractic lists it for patients 18 and older, next to its new patient form and informed consent form.
Is it the same as the new patient intake form?
At Shorewood they are separate forms. The new patient form holds contact, insurance, and referral details, and the health questionnaire holds the health history.
Does it include a symptom checklist?
Yes. The Shorewood version has a checklist of general symptoms, sections for men and women, questions for pregnant patients, and a body chart for marking pain.
Is there a chiropractic health questionnaire template?
The sample questions on this page show a typical set, based on the Shorewood Family Chiropractic form.
What happens if a patient checks a worrying symptom?
The avatar only records the answer. The chiropractor's team reviews the checklist and decides what happens next, following the practice's own protocol.
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.
