Menopause Symptom Questionnaire
What a menopause symptom questionnaire asks, with sample questions on hot flashes, other symptoms, and health history.
A menopause symptom questionnaire records the symptoms a patient notices, periods, family history, medicines, and lifestyle before a menopause visit. It's also called a menopause symptom checklist.
Menopause symptom questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a menopause symptom 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 menopause symptom questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- How often do you have hot flashes?Hot flashes
- Do you have night sweats?Hot flashes
- Do you have vaginal dryness?Other symptoms
- Which symptom bothers you most?Other symptoms
- When was the first day of your last period?Periods
- At what age did your periods stop?Periods
- Has anyone in your family had breast cancer?Family history
- Has a relative had heart disease or a stroke?Family history
- Which medicines, vitamins, or supplements do you take?Medicines
- Have you ever used hormone replacement therapy?Medicines
- Do you smoke now, or did you ever?Lifestyle
- How many cups of tea or coffee daily?Lifestyle
These are examples to read, not a form to fill in.
Menopause symptom questionnaire: FAQ
What does a menopause symptom questionnaire ask?
The sample questions on this page are based on a pre-appointment questionnaire of the Gibraltar Health Authority in Gibraltar and a Weill Cornell Medicine gynecology intake form. This page groups them into six areas: hot flashes, other symptoms, periods, family history, medicines, and lifestyle.
Who fills in a menopause symptom questionnaire?
The patient, before the menopause appointment. The Gibraltar Health Authority form asks the patient to try to answer all questions.
Is it the same as a menopause symptom checklist?
The first part is. The Gibraltar Health Authority form starts with a symptom checklist marked no, sometimes, or frequently, then adds family history, medicines, and lifestyle.
Does it ask about family history?
Yes. The Gibraltar Health Authority form asks about relatives with breast cancer, blood clots, heart disease, or stroke, and the age at diagnosis.
Does it ask about screening tests?
Yes. The Gibraltar Health Authority form asks whether the patient's Pap test and mammogram are up to date.
What happens after a menopause symptom questionnaire is completed?
The practice's team reviews the answers before the visit. AI Doctor only collects them and does not advise on hormone therapy.
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.
