Eosinophilic Esophagitis Questionnaire
What an eosinophilic esophagitis questionnaire asks, with sample questions on swallowing, allergies, and family history.
An eosinophilic esophagitis questionnaire records swallowing trouble, eating habits, reflux symptoms, allergies, and family history before a GI or allergy visit. Its questions are built from GI intake forms and an Asthma and Allergy Foundation of America guide to EoE.
Eosinophilic esophagitis questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an eosinophilic esophagitis 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 eosinophilic esophagitis questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Do you have trouble swallowing?Swallowing
- Is it hard to swallow dry or dense foods?Swallowing
- Do you cut food into very small pieces?Eating habits
- Do you drink liquids to wash food down?Eating habits
- Do you have heartburn or regurgitation?Reflux
- Has reflux medicine helped your symptoms?Reflux
- Do you have any food allergies?Allergies
- Do you have asthma, eczema, or hay fever?Allergies
- Do your parents have allergies or asthma?Family history
- Has anyone in your family had EoE?Family history
- Have you had an upper endoscopy with biopsies?Prior care
- Have you seen an allergist for these symptoms?Prior care
These are examples to read, not a form to fill in.
Eosinophilic esophagitis questionnaire: FAQ
What does an eosinophilic esophagitis questionnaire ask?
The sample questions on this page are based on GI intake forms and an Asthma and Allergy Foundation of America guide to EoE. This page groups them into six areas: swallowing, eating habits, reflux, allergies, family history, and prior care.
Who answers an eosinophilic esophagitis questionnaire?
The patient, or a parent when the patient is a child. One published report describes a Texas Children's Hospital clinic questionnaire in which parents record their own allergy history.
Why does it ask about allergies, asthma, and eczema?
The Asthma and Allergy Foundation of America guide says many people with EoE may also have personal or family allergies, asthma, allergic rhinitis, or eczema.
Why does it ask how the patient eats?
The same guide notes that people with EoE may manage symptoms by cutting food into smaller pieces or drinking liquids with dry foods.
Is it the same as an EoE history form?
It can be. EoE is the short name for eosinophilic esophagitis, and the Asthma and Allergy Foundation of America guide uses both names.
What happens after the eosinophilic esophagitis questionnaire is completed?
The GI or allergy team reviews the answers before the visit. AI Doctor only collects them and does not diagnose EoE.
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.
