Vitiligo Questionnaire
What a vitiligo questionnaire asks, with sample questions on onset, spread, and past treatment.
The vitiligo questionnaire on this page covers when the white patches appeared, how they have spread, past treatment, and related health history. Its questions are based on the patient questionnaire published by the Vitiligo Research Foundation, a US nonprofit.
Vitiligo questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a vitiligo 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 vitiligo questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is your date of birth?Background
- How would you describe your natural skin color?Background
- At what age did you first notice vitiligo?Onset
- Where on your body did it first appear?Onset
- Has it spread in the last month or two?Spread
- About how much of your skin is affected?Spread
- Which vitiligo treatments have you had so far?Past treatment
- Did it spread again after treatment ended?Past treatment
- Do you have any gray hair?Skin condition
- Do you sunburn easily?Skin condition
- Do you have a thyroid condition or diabetes?Health history
- Does anyone in your family have vitiligo?Health history
These are examples to read, not a form to fill in.
Vitiligo questionnaire: FAQ
What does a vitiligo questionnaire ask?
The sample questions on this page are based on the Vitiligo Research Foundation's Vitiligo Questionnaire, version 4.0. This page groups them into six areas: background, onset, spread, past treatment, skin condition, and health history.
Who answers a vitiligo questionnaire, and when?
The patient, about their own skin. Each practice decides when to ask, for example before a first dermatology visit.
Is the foundation's questionnaire a clinic form?
No. It is an anonymous questionnaire that collects answers for research. It states that its contents are based on the foundation's Vitiligo Health Record for clinicians.
Is there a vitiligo questionnaire template?
The Vitiligo Research Foundation publishes its questionnaire as a PDF. It says the form may be reprinted for educational or non-commercial use only. The sample questions on this page show a typical set.
Does the questionnaire ask for photos?
The foundation's questionnaire lets patients attach a photo of the affected area. AI Doctor does not take or analyze photos.
What happens after the patient answers?
The practice's team reviews the answers before the visit. AI Doctor only collects them and does not assess the skin.
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.
