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ENT Intake Forms

Every intake form and ENT questionnaire an ear, nose, and throat practice uses, explained: what each one asks and why.

From the new patient questionnaire to hearing, sinus, voice, and head and neck forms, plus scored tools like SNOT-22. Pick a form to see its questions.

Patients answering ENT intake questions with the AI Doctor avatar at clinic check-in kiosks

ENT intake forms by area

Forms grouped by the area of ENT that uses them. Every practice words its own forms differently; each page shows what a typical form asks.

General ENT

5 forms
  • ENT established patient questionnaire Coming soon
  • ENT new patient questionnaire Coming soon
  • ENT post-op follow-up form Coming soon
  • ENT pre-op questionnaire Coming soon
  • ENT telehealth intake Coming soon

Ear, hearing and balance

8 forms
  • Dizziness handicap inventory Coming soon
  • Dizziness intake form Coming soon
  • Ear infection evaluation Coming soon
  • Hearing handicap inventory Coming soon
  • Hearing loss evaluation Coming soon
  • Sudden hearing loss evaluation Coming soon
  • Tinnitus evaluation Coming soon
  • Tinnitus handicap inventory Coming soon

Nose and sinus

8 forms
  • Broken nose evaluation Coming soon
  • ENT allergy evaluation Coming soon
  • Loss of smell evaluation Coming soon
  • Nasal obstruction evaluation Coming soon
  • Recurrent nosebleeds evaluation Coming soon
  • Sinus new patient questionnaire Coming soon
  • Snoring evaluation ENT Coming soon
  • SNOT-22 questionnaire Coming soon

Throat and voice

6 forms
  • Chronic sore throat evaluation Coming soon
  • Difficulty swallowing evaluation Coming soon
  • EAT-10 swallowing questionnaire Coming soon
  • Hoarseness evaluation Coming soon
  • Throat reflux symptoms evaluation Coming soon
  • Voice handicap index Coming soon

Pediatric ENT

7 forms
  • Child hearing loss evaluation Coming soon
  • Child snoring evaluation Coming soon
  • Ear tubes consultation Coming soon
  • Infant noisy breathing evaluation Coming soon
  • Pediatric ENT new patient Coming soon
  • Tongue tie evaluation Coming soon
  • Tonsillectomy consultation Coming soon

Head and neck

5 forms
  • Facial paralysis evaluation Coming soon
  • Head and neck cancer new patient Coming soon
  • Neck lump evaluation Coming soon
  • Salivary gland swelling evaluation Coming soon
  • Thyroid nodule evaluation Coming soon

ENT intake forms: FAQ

What intake forms does an ENT practice use?

Most start with a new patient questionnaire covering symptoms, past ear, nose, and throat problems, surgeries, medicines, and allergies. Problem-specific forms then go deeper, for example on hearing loss, dizziness, sinus symptoms, hoarseness, or a neck lump. Surgical patients also get pre-op and post-op forms.

What is the difference between an ENT intake form and an ENT questionnaire?

In practice the terms overlap. An intake form usually collects history and current symptoms before a visit. A questionnaire often means a scored tool, such as SNOT-22 for sinus symptoms or the Dizziness Handicap Inventory, which practices repeat over time to track change.

Which scored questionnaires do ENT practices use?

Common ones include SNOT-22, a 22-item sinonasal symptom test, the 25-item Dizziness Handicap Inventory, and EAT-10, a 10-item swallowing screen. Practices also use hearing, tinnitus, and voice handicap inventories. Each has its own scoring, so the form page explains what it asks.

Who fills in ENT intake forms?

Adult patients fill in their own forms. For children, a parent or guardian answers, often with details only they know, such as snoring at night, ear infections, or feeding problems in an infant. The ENT team reviews the answers before or during the visit.

How are pediatric ENT forms different?

They ask about birth history, development, speech, school, and how often a child has ear infections or sore throats. Snoring and breathing during sleep get their own questions. Forms for tonsil or ear tube consultations focus on how often problems recur and how they affect daily life.

How does AI Doctor help an ENT practice?

AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language, and collects the answers for the team to review before the visit. It does not diagnose, triage or give medical advice.

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.

  1. 01Choose the AI Doctor avatar.
  2. 02Add your practice's FAQs and visit information.
  3. 03Talk to it, then publish it.
Setting up AI Doctor for ENT intake forms in Genesis AI Avatar Studio on a laptop