Hair Loss Questionnaire
What a hair loss questionnaire asks, the areas it covers, and sample questions for practice staff.
The hair loss questionnaire on this page covers when the hair loss started, family history, recent illness, medications, hormones, and hair care. Bay Area Dermatology and ColumbiaDoctors publish their own versions for patients to complete.
Hair loss questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a hair loss 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 hair loss questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- When did you first notice losing hair?Onset
- Is your hair shedding or looking thinner?Onset
- Does anyone in your family have hair loss?Family history
- Do any women in your family have thin hair?Family history
- Any surgery or hospital stay in the past year?Recent events
- Have you had a baby in the last year?Recent events
- Which medications are you taking right now?Medications
- Do you take any vitamins or natural products?Medications
- Have you been told you have a thyroid condition?Health history
- Have you ever been told your iron is low?Health history
- How often is your hair chemically processed?Hair care
- Do you wear braids, weaves, or tight hairstyles?Hair care
These are examples to read, not a form to fill in.
Hair loss questionnaire: FAQ
What does a hair loss questionnaire ask?
The sample questions on this page are based on hair loss questionnaires from Bay Area Dermatology and ColumbiaDoctors. This page groups them into six areas: onset, family history, recent events, medications, health history, and hair care.
Who fills in a hair loss questionnaire?
The patient. Both source forms are written for the patient to complete, with yes or no boxes and short written answers.
Which recent events does the form ask about?
The Bay Area Dermatology form asks about surgery, hospital stays, severe infections or high fever, and a new baby in the last year. The ColumbiaDoctors form also asks about severe stress.
Does the form ask about hair care habits?
The ColumbiaDoctors form does. It asks how often hair is washed, chemically processed, heat styled, or colored, and about braids, weaves, and tight hairstyles.
Is there a hair loss questionnaire template?
Bay Area Dermatology and ColumbiaDoctors publish their hair loss questionnaires as PDFs. The sample questions on this page show a typical set.
What happens after the questions are answered?
The practice's team reviews the answers before the visit. AI Doctor records what the patient says and does not suggest a cause or a treatment.
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.
