Glaucoma Patient History Form
What a glaucoma patient history form asks, with sample questions on eye drops, eye surgery, and family history.
A glaucoma patient history form records current vision problems, past eye surgery, eye drops, general health, and family eye history before a first glaucoma visit. The questions on this page are built from the new patient forms of two glaucoma practices in Texas and another practice's glaucoma survey.
Glaucoma patient history form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a glaucoma patient history form 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 glaucoma patient history form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What vision problems are you having now?Eye history
- Have you ever had eye surgery?Eye history
- Which eye drops do you use now?Eye drops
- Do your eye drops cause burning or redness?Eye drops
- Which medicines do you take, besides eye drops?Medical history
- Do you have any drug allergies?Medical history
- Has anyone in your family had glaucoma?Family history
- Does a relative have macular degeneration?Family history
- Do you have trouble driving at night?Daily life
- Do you live alone or need help at home?Daily life
- Do you smoke, and how much?Social history
- How often do you drink alcohol?Social history
These are examples to read, not a form to fill in.
Glaucoma patient history form: FAQ
What does a glaucoma patient history form ask?
The sample questions on this page are based on two Texas glaucoma practices' new patient forms and another practice's glaucoma patient survey. This page groups them into six areas: eye history, eye drops, medical history, family history, daily life, and social history.
Who fills in a glaucoma patient history form, and when?
The patient or a family member, before the first visit. One of the Texas practices asks patients to bring the completed form along with all their medicines, including eye drops.
Does it ask about family history?
One Texas form asks whether relatives have had glaucoma, cataracts, macular degeneration, or retinal detachment. The other asks the same about general conditions such as diabetes and high blood pressure.
Does the form ask about eye drops?
One form asks for a list of current eye medicines. A glaucoma patient survey from another practice also asks how easy the drops are to use and whether they cause burning, redness, or itching.
Is there a glaucoma patient history form template?
Both Texas practices publish their forms as PDFs. The sample questions on this page show a typical set.
What happens after the form is completed?
The practice's team reviews the answers before the visit. One Texas form ends with a line where the physician notes the date the history was reviewed.
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.
