PMS Symptom Questionnaire
What a PMS symptom questionnaire asks, with sample questions on periods, cycle timing, and pain.
A PMS symptom questionnaire records the period pattern, symptoms around the cycle, period pain and its effect on daily life, and treatments tried before a gynecology visit. Its questions are built from period questions in forms from Stanford Medicine Partners, Northwestern Medicine, and Canterbury District Health Board in New Zealand.
PMS symptom questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a PMS 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 PMS symptom questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- When did your last period start?Periods
- How long does your period usually last?Periods
- Does the pain change during your cycle?Cycle timing
- Is it worse a few days before bleeding?Cycle timing
- Are your periods painful?Period pain
- Do your periods make you miss work or activities?Period pain
- Do you have PMS symptoms you want to discuss?PMS symptoms
- Can you describe your PMS symptoms?PMS symptoms
- Does your birth control help your period pain?Treatments tried
- Which medicines have you tried for period pain?Treatments tried
- Which prescribed medicines do you take now?Health history
- Do you have endometriosis or fibroids?Health history
These are examples to read, not a form to fill in.
PMS symptom questionnaire: FAQ
What does a PMS symptom questionnaire ask?
The sample questions on this page are built from period questions in forms from Stanford Medicine Partners, Northwestern Medicine, and Canterbury District Health Board in New Zealand. This page groups them into six areas: periods, cycle timing, period pain, PMS symptoms, treatments tried, and health history.
Who answers a PMS symptom questionnaire, and when?
The patient, before a gynecology visit. On the Stanford Medicine Partners well-woman form, PMS symptoms appear in the list of symptoms the patient has now.
Where do PMS questions sit on gynecology forms?
On the Northwestern Medicine form, PMS is one of the gynecologic conditions the patient checks and describes, next to painful periods, fibroids, and endometriosis.
Does it ask how periods affect daily life?
Yes. The Stanford Medicine Partners new patient form asks whether periods cause the patient to miss work or activities.
Is there a PMS symptom questionnaire template?
The sample questions on this page show a typical set, built from period questions in general gynecology forms.
What happens after the form is completed?
The practice's team reviews the answers before the visit. AI Doctor records what the patient reports and does not decide whether it is PMS.
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.
