Endometriosis Questionnaire
What an endometriosis questionnaire asks, with sample questions on period pain, bowel symptoms, and fertility.
The endometriosis questionnaire on this page covers period pain, pain between periods, bowel symptoms, fertility plans, and past diagnosis before a gynecology visit. The questions come from gynecology intake forms from Washington University in St. Louis, Northwestern Medicine, Stanford Health Care, and UCLA Health.
Endometriosis questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an endometriosis 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 endometriosis questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What problems would you like help with?Visit reason
- Who referred you for this visit?Visit reason
- Do you have pain with your periods?Periods
- How many days apart do your periods start?Periods
- Is the pain before or during your period?Pain
- Do you have any pain between periods?Pain
- Are bowel movements painful during your period?Bowel symptoms
- Do you have problems with constipation?Bowel symptoms
- Have you had problems with fertility?Fertility
- Do you hope to become pregnant in the future?Fertility
- Have you been diagnosed with endometriosis before?Medical history
- Have you ever had a laparoscopy?Medical history
These are examples to read, not a form to fill in.
Endometriosis questionnaire: FAQ
What does an endometriosis questionnaire ask?
The sample questions on this page are built from gynecology intake forms from Washington University in St. Louis, Northwestern Medicine, Stanford Health Care, and UCLA Health. This page groups them into six areas: visit reason, periods, pain, bowel symptoms, fertility, and medical history.
Who fills in an endometriosis questionnaire?
The patient, before a gynecology or surgical consultation. The Northwestern Medicine form says its answers help the team evaluate care needs before the first visit.
Does it ask about bowel symptoms?
Yes. The Washington University form lists painful bowel movements during periods, and the Stanford Health Care form asks about constipation.
Does an endometriosis questionnaire ask about sex?
Yes. The Stanford Health Care form asks whether intercourse is painful and whether the pain comes with insertion or deeper.
Does it ask about fertility plans?
Yes. The Stanford Health Care form asks whether the patient wants future fertility, and the Northwestern Medicine form lists fertility problems.
What happens after the questionnaire is completed?
The gynecology team reviews the answers before the visit. AI Doctor collects them and does not suggest a diagnosis.
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.
