Double Vision Questionnaire
What a double vision questionnaire asks, with sample questions on when it started, what it looks like, and earlier tests.
A double vision questionnaire records when the double vision started, what it looks like, its triggers, and eye history before an eye visit. The questions on this page are built from a neuro-optometry practice's double vision form and the adult questionnaire of St. Louis Children's Hospital Eye Center.
Double vision questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a double vision 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 double vision questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- When did the double vision start?Onset
- Has it gotten better, worse, or stayed the same?Onset
- Are the two images side by side or stacked?Pattern
- Is it constant, or does it come and go?Pattern
- What makes the double vision better or worse?Triggers
- Is it worse at the end of the day?Triggers
- Have you had eye muscle surgery before?Eye history
- Did you wear an eye patch as a child?Eye history
- Have you had brain scans or lab work?Past tests
- When and where were those tests done?Past tests
- Does anyone in your family have an eye turn?Family history
- Has a relative been treated for lazy eye?Family history
These are examples to read, not a form to fill in.
Double vision questionnaire: FAQ
What does a double vision questionnaire ask?
The sample questions here are based on a neuro-optometry practice's double vision history form and the St. Louis Children's Hospital Eye Center adult questionnaire. This page groups them into six areas: onset, pattern, triggers, eye history, past tests, and family history.
Who fills in a double vision questionnaire, and when?
The patient, before the eye visit. The St. Louis Children's Hospital Eye Center form asks the patient to complete every section and to name other providers who need a report.
Does it ask about childhood eye problems?
The neuro-optometry form asks about past patching, eye muscle surgery, vision therapy, and glasses at a young age. It also asks about relatives with an eye turn or lazy eye.
Does it ask about earlier scans?
Yes. The neuro-optometry form asks whether brain imaging or lab work was done, when, and what type, such as a CT or MRI.
Is there a template for this form?
Both source forms are published as PDFs. The sample questions on this page show a typical set.
What happens after the double vision questionnaire is completed?
The practice's team reviews the answers and plans the exam. AI Doctor collects the answers and does not assess them.
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.
