Gynecologic Surgery New Patient Questionnaire
What a gynecologic surgery new patient questionnaire asks, with sample questions for surgical teams.
A gynecologic surgery new patient questionnaire records the reason for seeking care, gynecologic and medical history, surgeries, medicines, and family history before a surgical consult. It's also called a MIGS new patient questionnaire.
Gynecologic surgery new patient questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a gynecologic surgery 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 gynecologic surgery new patient questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What problems are you seeking care for?Visit reason
- Who is your referring physician?Visit reason
- When was your last Pap test?Gynecologic history
- What contraception do you currently use?Gynecologic history
- Have you been diagnosed with fibroids or endometriosis?Conditions
- Do you have any urinary leaking?Conditions
- Have you been told you have sleep apnea?Medical history
- Do you have heart, kidney, or liver disease?Medical history
- What surgeries have you had, and when?Surgeries
- Where was each surgery done, and by whom?Surgeries
- Which medicines, vitamins, and supplements do you take?Medicines
- Are you allergic to any medicines?Medicines
These are examples to read, not a form to fill in.
Gynecologic surgery new patient questionnaire: FAQ
What does a gynecologic surgery new patient questionnaire ask?
The sample questions on this page are based on the new patient health questionnaire of the Minimally Invasive Gynecologic Surgery Program at Northwestern Medicine. This page groups them into six areas: visit reason, gynecologic history, conditions, medical history, surgeries, and medicines.
Who fills in a gynecologic surgery new patient questionnaire?
The patient, before the first visit. The Northwestern Medicine form says the answers help the team evaluate care needs and streamline that first visit.
Is it the same as a gynecologic surgery consult form?
It can be. The Northwestern Medicine form, titled New Patient Health Questionnaire, is used before the first visit to its minimally invasive gynecologic surgery program.
Does it ask about family reactions to anesthesia?
Yes. The family history section asks about breast, ovarian, and colon cancer, blood clots, and reactions to anesthesia in parents, grandparents, siblings, and children.
Does it include consent for surgery?
No. The Northwestern Medicine form records health history only and has no consent section.
What happens after the questionnaire is completed?
The form ends with an office-use box where staff note who reviewed it and when. AI Doctor collects the answers only.
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.
