Diverticulitis Questionnaire
What a diverticulitis questionnaire asks, with sample questions on past episodes, bowel habits, tests, and family history.
A diverticulitis questionnaire records the visit reason, past diverticulitis episodes, bowel habits, earlier colonoscopy and CT scans, and health and family history before a visit. The questions on this page come from colorectal surgery and gastroenterology new patient forms that list diverticulitis.
Diverticulitis questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a diverticulitis 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 diverticulitis 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?Visit reason
- Who are your gastroenterologist and primary doctor?Visit reason
- Have you been told you have diverticulitis?Past episodes
- How many episodes have you had so far?Past episodes
- Have your bowel habits changed recently?Bowel habits
- Do you have constipation?Bowel habits
- When was your last colonoscopy?Past tests
- Have you had a CT scan of your abdomen?Past tests
- Which medicines have you taken for this problem?Health history
- Have you had any colon surgery?Health history
- Has anyone in your family had diverticulitis?Family history
- Has a relative had colorectal polyps or cancer?Family history
These are examples to read, not a form to fill in.
Diverticulitis questionnaire: FAQ
What does a diverticulitis questionnaire ask?
The sample questions here are based on the Rutgers Robert Wood Johnson Medical School colorectal surgery questionnaire and GI new patient forms that list diverticulitis. This page groups them into six areas: visit reason, past episodes, bowel habits, past tests, health history, and family history.
Who fills in a diverticulitis questionnaire, and when?
The patient, before a gastroenterology or colorectal surgery visit about diverticular disease. The Rutgers form also asks for the patient's gastroenterologist, primary doctor, and pharmacy.
Does it ask about earlier colonoscopy and scans?
The Rutgers form asks for the year of the last colonoscopy and what it found. A colon and rectal surgery history form asks where and when a CT of the abdomen was done.
Does it ask about family history?
Yes. The Rutgers form asks whether family members have had colorectal cancer or polyps, and a GI practice's form also lists diverticulitis in its family history.
Is there a diverticulitis questionnaire template?
The sample questions on this page show a typical set. They come from colorectal and gastroenterology intake forms that include diverticulitis.
What happens with the answers?
The practice's team reviews them before the visit and decides on any follow-up. AI Doctor only collects the answers; it does not assess abdominal pain.
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.
