ENT New Patient Questionnaire
What an ENT new patient questionnaire asks, the areas it covers, and sample questions for practice staff.
The ENT new patient questionnaire on this page covers the reason for a first ENT visit, past history, medications, allergies, and current symptoms. It's also called an otolaryngology health history questionnaire.
ENT new patient questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an ENT new patient 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 ENT new patient 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 today?Visit reason
- Who referred you to our practice?Visit reason
- Which surgeries or hospital stays have you had?Past history
- Have you ever had a problem with anesthesia?Past history
- Do you take aspirin or other blood thinners?Medications
- Have you taken oral steroids in the past year?Medications
- Are you allergic to any medications?Allergies
- Have you ever had allergy skin testing?Allergies
- Do you smoke or use other tobacco?Social history
- How often do you drink alcohol?Social history
- Have you noticed hearing loss or ringing?Symptom review
- Have you had nasal congestion or drainage?Symptom review
These are examples to read, not a form to fill in.
ENT new patient questionnaire: FAQ
What does an ENT new patient questionnaire ask?
The sample questions on this page are based on new patient forms from NorthShore's Division of Otolaryngology and University of Michigan Otolaryngology. This page groups them into six areas: visit reason, past history, medications, allergies, social history, and symptom review.
Who fills in an ENT new patient questionnaire, and when?
The patient, before the first appointment. The University of Michigan form asks patients to complete it as fully as possible and bring it to the visit.
Is it the same as an otolaryngology health history questionnaire?
Yes. University of Michigan titles its form Health History Questionnaire, New Patient, Otolaryngology.
What does the form ask about medications?
A list of current medications with dose and frequency. NorthShore's form also asks about blood thinners such as aspirin and ibuprofen, and about oral steroids in the past year.
Is there an ENT new patient questionnaire template?
NorthShore and University of Michigan both publish their forms as PDFs. The sample questions on this page show a typical set.
What happens after the form is completed?
The practice's team reviews the answers before the visit. NorthShore's form ends with a line where the physician confirms the review with the patient.
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.
