Low Vision Evaluation Questionnaire
What a low vision evaluation questionnaire asks, with sample questions on daily tasks, aids, and goals.
A low vision evaluation questionnaire records the patient's eye condition, current aids, everyday tasks, getting around, and goals before a low vision evaluation. The Vista Center Low Vision Clinic calls its version a pre-visit evaluation questionnaire.
Low vision evaluation questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a low vision evaluation 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 low vision evaluation questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What eye condition has been diagnosed?Eye condition
- When was your eye condition first diagnosed?Eye condition
- Which medications do you take?General health
- Can you manage your medications by yourself?General health
- Which magnifiers or other devices do you use?Current aids
- How old is your glasses prescription?Current aids
- Can you read regular or large print?Daily tasks
- Can you see well enough to tell time?Daily tasks
- Do you use a cane, walker, or wheelchair?Getting around
- How do you usually travel outside your home?Getting around
- What would you like to do better?Goals
- Which equipment would you like demonstrated?Goals
These are examples to read, not a form to fill in.
Low vision evaluation questionnaire: FAQ
What does a low vision evaluation questionnaire ask?
The sample questions on this page are based on the Vista Center Low Vision Clinic's Pre-Visit Evaluation Questionnaire. This page groups them into six areas: eye condition, general health, current aids, daily tasks, getting around, and goals.
Who fills in a low vision evaluation questionnaire, and when?
The patient, before the low vision appointment. The Vista Center form asks patients to complete it and bring it with them to the evaluation.
How does the form cover everyday tasks?
The Vista Center form goes through reading, writing, cooking, phones, and television. For each task, it asks how hard it is, whether vision loss is the reason, and whether the patient wants to do it better.
Does it ask about the patient's goals?
Yes. The Vista Center form asks what the patient wants from the visit, such as reading, writing, or using a computer, and which devices to demonstrate.
Is there a low vision evaluation questionnaire template?
The Vista Center Low Vision Clinic publishes its questionnaire as a PDF. The sample questions on this page show a typical set.
What happens after the questionnaire is completed?
The practice's team reviews the answers before the evaluation. The Vista Center form closes by asking for anything else that would help plan the patient's low vision aids.
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.
