Heavy Periods Questionnaire
What a heavy periods questionnaire asks, with sample questions on cycle pattern, heavy days, clots, and bleeding history.
The heavy periods questionnaire on this page covers cycle pattern, heavy days, clots and spotting, period pain, anemia, and bleeding history before a gynecology visit. The questions come from the period sections of forms from Stanford Health Care, HonorHealth, UCLA Health, and Weill Cornell Medicine.
Heavy periods questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a heavy periods 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 heavy periods questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Are your periods regular or irregular?Cycle pattern
- How many days does your bleeding last?Cycle pattern
- How many of your bleeding days are heavy?Heavy days
- Do you wear pads, tampons, or both?Heavy days
- Do you pass clots during your period?Clots
- How large are the clots you pass?Clots
- Are your periods painful?Period pain
- On how many days do periods hurt?Period pain
- Have you ever been told you have anemia?Anemia history
- Have you ever needed a blood transfusion?Anemia history
- Do you bruise or bleed easily?Bleeding history
- Has a relative had a bleeding disorder?Bleeding history
These are examples to read, not a form to fill in.
Heavy periods questionnaire: FAQ
What does a heavy periods questionnaire ask?
The sample questions on this page are built from the period sections of forms from Stanford Health Care, HonorHealth, UCLA Health, and Weill Cornell Medicine. This page groups them into six areas: cycle pattern, heavy days, clots, period pain, anemia history, and bleeding history.
Who answers these questions?
The patient, before a gynecology visit about heavy or irregular periods.
Does it ask about clots?
Yes, the Stanford Health Care form asks whether the patient passes clots and how big they are. The HonorHealth form asks about clots larger than a quarter.
Does a heavy periods questionnaire ask about bleeding disorders?
Yes. The Weill Cornell Medicine form asks about a family history of bleeding disorders, and its symptom list includes easy bruising.
Is there a heavy periods questionnaire template?
The sample questions on this page show a typical set, taken from the period and bleeding sections of four gynecology forms.
What happens after the questionnaire is completed?
The care team reviews the bleeding history before the visit. AI Doctor records the answers and does not judge whether the bleeding is normal.
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.
