Myopia Control Consultation Form
What a myopia control consultation form asks the parent, with sample questions on family history, outdoor time, and near work.
A myopia control consultation form records a child's eye history, family nearsightedness, outdoor time, near work, and past treatment before a myopia control visit. The sample questions on this page are built from a Canadian eye practice's myopia questionnaire and the International Myopia Institute's history-taking guidance.
Myopia control consultation form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a myopia control consultation 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 myopia control consultation form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- At what age did your child start wearing glasses?Eye history
- When was your child's last eye exam?Eye history
- Which parents or siblings are nearsighted?Family history
- Has anyone in the family had LASIK or PRK?Family history
- How much time does your child spend outdoors daily?Outdoor time
- Does outdoor time change between summer and winter?Outdoor time
- How much daily screen time does your child have?Near work
- Where does your child do homework?Near work
- Has your child tried any myopia control treatment?Past treatment
- How well did the earlier treatment work?Past treatment
- Does your child have any allergies?Health history
- What medicines or supplements does your child take?Health history
These are examples to read, not a form to fill in.
Myopia control consultation form: FAQ
What does a myopia control consultation form ask?
The sample questions on this page are based on a Canadian eye practice's myopia questionnaire and the International Myopia Institute Clinical Management Guidelines Report. This page groups them into six areas: eye history, family history, outdoor time, near work, past treatment, and health history.
Who fills in a myopia control consultation form?
A parent or caregiver answers for the child before the consultation. The Canadian practice's questionnaire asks for it back at least 48 hours before the appointment.
Why does it ask about outdoor time and near work?
The International Myopia Institute guidelines link near work and time outdoors to myopia. They suggest recording a child's daily hours of each.
Does it ask about the parents' eyesight?
Yes. The practice questionnaire asks which parents or siblings are nearsighted, when they got their first glasses, and their current prescription.
Is there a myopia control consultation form template?
The sample questions on this page show a typical set. The International Myopia Institute report lists the history points a baseline exam covers.
What happens after the form is completed?
The eye doctor reviews the answers before the consultation. AI Doctor only collects them; it does not recommend lenses, drops, or any treatment.
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.
