Thyroid Eye Disease Questionnaire
What a thyroid eye disease questionnaire asks, with sample questions on thyroid treatment, eye history, and smoking.
A thyroid eye disease questionnaire records the patient's thyroid status and treatment, recent thyroid tests, eye history, smoking, and family history before an eye visit. The questions on this page are a typical set built from a Canadian university referral form and the thyroid items on eye clinic forms.
Thyroid eye disease questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a thyroid eye disease 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 thyroid eye disease questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Is your thyroid overactive, underactive, or normal now?Thyroid status
- When were your thyroid levels last tested?Thyroid status
- How is your thyroid condition being treated?Thyroid treatment
- Have you been treated for an overactive thyroid?Thyroid treatment
- When did you first notice changes in your eyes?Eye history
- Have you had eye surgery before?Eye history
- Have you had a CT scan of the orbits?Past tests
- Have you had thyroid antibody blood tests?Past tests
- Do you smoke now?Smoking
- Have you smoked in the past?Smoking
- Does anyone in your family have thyroid problems?Family history
- Which relatives have had eye problems?Family history
These are examples to read, not a form to fill in.
Thyroid eye disease questionnaire: FAQ
What does a thyroid eye disease questionnaire ask?
The sample questions on this page are based on a University of Toronto (Canada) Graves' orbitopathy referral form and eye clinic history forms. This page groups them into six areas: thyroid status, thyroid treatment, eye history, past tests, smoking, and family history.
Who fills in a thyroid eye disease questionnaire?
The patient, before the eye visit. On the Toronto form, the referring doctor records the same thyroid details when sending a patient to an oculoplastics clinic.
Does it ask about thyroid treatment?
The sample questions include it. The Toronto referral form records current thyroid status, the latest thyroid blood tests, and how hyperthyroidism is being managed.
Does it ask about smoking?
The Toronto referral form records current smoking status. The New York Eye and Ear Infirmary of Mount Sinai pre-admission form asks about past and current tobacco use.
Is there a thyroid eye disease questionnaire template?
The Toronto referral form is published as a PDF for doctors. The sample questions on this page show a typical set for patients.
What happens after the form is completed?
The care team reviews the answers, and any eye symptoms are handled under the practice's own protocol. AI Doctor records 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.
