Eye Injection Pre-Treatment Questionnaire
What an eye injection pre-treatment questionnaire asks, with sample questions on recent health, medicines, and allergies.
An eye injection pre-treatment questionnaire records recent health, the treated eye, medicines, allergies, current illness, and pregnancy before an injection into the eye. The questions on this page are built from a macular degeneration trial's visit form and UK and Irish hospital leaflets on eye injections.
Eye injection pre-treatment questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an eye injection pre-treatment 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 eye injection pre-treatment questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Have you had any injuries since your last visit?Recent health
- Have you been hospitalized since your last visit?Recent health
- Which eye is being treated today?Treated eye
- Have you had eye procedures since your last visit?Treated eye
- Have your medicines changed since the last visit?Medicines
- Do you take vitamins or dietary supplements?Medicines
- Are you allergic to povidone-iodine?Allergies
- Are you allergic to the injection medicine?Allergies
- Do you have an eye infection right now?Current illness
- Are you feeling unwell from a current illness?Current illness
- Are you pregnant or breastfeeding?Pregnancy
- Are you trying to become pregnant?Pregnancy
These are examples to read, not a form to fill in.
Eye injection pre-treatment questionnaire: FAQ
What does an eye injection pre-treatment questionnaire ask?
The sample questions here are based on a Comparison of Age-related Macular Degeneration Treatments Trials (CATT) visit form and UK and Irish hospital leaflets. This page groups them into six areas: recent health, treated eye, medicines, allergies, current illness, and pregnancy.
Who answers an eye injection pre-treatment questionnaire, and when?
The patient, on the day of the injection visit, before the treatment. In the CATT trial, a clinic coordinator read the questions aloud to the patient at each follow-up visit.
Does it ask about allergies?
Yes. A Moorfields Eye Hospital (London, UK) leaflet asks patients with a known povidone-iodine allergy to tell the eye doctor at the injection appointment.
Does it ask about pregnancy?
Yes. A Royal Victoria Eye and Ear Hospital (Dublin, Ireland) leaflet asks patients to tell staff about pregnancy, trying to conceive, or breastfeeding.
Is there an eye injection pre-treatment questionnaire template?
The sample questions on this page show a typical set. The practice's own injection protocol decides the final list.
What happens after the questionnaire is completed?
The care team reviews the answers before the injection. The decision to treat stays with the clinician; AI Doctor only asks the questions and records the answers.
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.
