Pediatric Pain Clinic Intake
What a pediatric pain clinic intake asks, with sample questions for parents on pain, past care, school, and family.
A pediatric pain clinic intake records how a child's pain started, past care, and how pain affects school and family before a first visit. The sample questions are based on the Seattle Children's Caregiver Pain Questionnaire, which a parent completes.
Pediatric pain clinic intake, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a pediatric pain clinic intake 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 pediatric pain clinic intake questions
Sample questions, written out so you can see the level of detail. Every practice words its own form differently.
- When did your child first have pain?Pain onset
- Did an illness or event come before the pain?Pain onset
- Which parts of your child's body are painful?Pain pattern
- How long does a typical pain episode last?Pain pattern
- Which pain medicines has your child used?Past care
- Which doctors or therapists have treated this pain?Past care
- How much school has your child missed this year?School
- Is a 504 Plan in place at school?School
- Who is in your household?Family
- Do any relatives have pain like your child's?Family
- How would better pain control change your child's life?Goals
- What do you hope this clinic visit achieves?Goals
These are examples to read, not a form to fill in.
Pediatric pain clinic intake: FAQ
What does a pediatric pain clinic intake ask?
The sample questions on this page are based on the Seattle Children's Caregiver Pain Questionnaire. This page groups them into six areas: pain onset, pain pattern, past care, school, family, and goals.
Who fills in a pediatric pain clinic intake?
A parent or caregiver. Seattle Children's asks a parent to complete its questionnaire, and the child completes a separate one if they are able.
When is the form due?
Seattle Children's asks for both questionnaires 1 week before the appointment.
Does it ask about school?
Yes. The Seattle Children's form asks about grade level, a 504 Plan or Individualized Education Plan, days missed, and how pain affects attendance.
Is there a template for it?
The sample questions on this page show a typical set. They come from one children's hospital form, written for the parent.
What happens after a pediatric pain clinic intake is completed?
The clinic's team reads the parent's answers before the visit. AI Doctor only collects them and does not explain a child's pain or suggest care.
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.
