Difficulty Swallowing Questionnaire
What a difficulty swallowing questionnaire asks in gastroenterology, with sample questions on reflux, medicines, and past tests.
A difficulty swallowing questionnaire records pain on swallowing, reflux, weight change, medicines, and past GI tests before a gastroenterology visit. Its questions come from the swallowing and reflux items on GI intake and procedure forms.
Difficulty swallowing questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a difficulty swallowing 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 difficulty swallowing questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Do you have difficulty swallowing?Swallowing
- Do you have pain when swallowing?Swallowing
- Do you have heartburn?Reflux
- Does food or liquid come back up?Reflux
- Has your weight gone up or down recently?Weight change
- Have you had stomach or weight-loss surgery?Weight change
- Which prescription and over-the-counter medicines do you take?Medicines
- Do you take medicines for pain?Medicines
- Have you had an upper endoscopy before?Past tests
- Have you had an upper GI X-ray series?Past tests
- Have you had a stroke?Health history
- Do you have any food allergies?Health history
These are examples to read, not a form to fill in.
Difficulty swallowing questionnaire: FAQ
What does a difficulty swallowing questionnaire ask?
The sample questions on this page are based on GI forms from University of Iowa Health Care, HealthPartners, and a gastroenterology practice. This page groups them into six areas: swallowing, reflux, weight change, medicines, past tests, and health history.
Who fills in a difficulty swallowing questionnaire?
The patient, before a first GI visit. A gastroenterology practice's new patient questionnaire lists difficulty swallowing among the GI problems the patient marks.
How is this different from an ENT swallowing evaluation?
The questions here come from gastroenterology forms and add reflux, past upper endoscopy, and GI history. RAVATAR has a separate page for the ENT difficulty swallowing evaluation.
Why does it ask for every medicine, including over-the-counter ones?
In a UCLA Health article, a gastroenterologist explains that some medicines, including over-the-counter ones, can cause dry mouth and make swallowing difficult. That is why the doctor needs the exact list.
Does it ask about past GI tests?
Yes. A gastroenterology practice's new patient questionnaire asks when the patient had an upper endoscopy (EGD) or an upper GI series X-ray.
What happens after the difficulty swallowing questionnaire is completed?
The GI team reviews the answers before the visit and decides on next steps. AI Doctor records them and does not decide whether a test is needed.
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.
