Ophthalmology Intake Forms

Most start with a new patient eye exam form: vision complaints, glasses or contacts, eye history, family history of eye disease, general health, and medicines. Subspecialty clinics add their own forms for cataract, glaucoma, retina, cornea, or eyelid problems, plus pre-op and follow-up questionnaires for surgery.

Many general conditions and medicines can affect the eyes, so eye doctors ask about them. Diabetes and high blood pressure are common examples. Before surgery, forms also ask about blood thinners and other medicines that can matter for the procedure.

Some eye conditions, such as glaucoma and macular degeneration, can run in families. A family history question helps the eye doctor decide what to look for during the exam.

The Ocular Surface Disease Index is a 12-item questionnaire about dry eye symptoms, how they affect vision-related tasks, and environmental triggers. Each item is scored 0 to 4 and the total is converted to a 0 to 100 score. Practices often repeat it to see how symptoms change with treatment.

A parent or guardian answers. The forms ask about pregnancy and birth, development, eye turning or squinting, how the child sees at school, and family history of lazy eye or strabismus. Myopia control and vision therapy forms add questions about screen time and reading habits.

AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language, and collects the answers for the team to review before the visit. It does not diagnose, triage or give medical advice.

No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.

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.