Sciatica Questionnaire
What a sciatica questionnaire asks, with sample questions for pain clinic staff.
A sciatica questionnaire records where leg pain goes, walking distance, pain triggers, and past imaging and injections before a spine or pain clinic visit. The questions here come from leg pain items on Main Line Health, Naples Comprehensive Health, and UCLA Health spine intake forms.
Sciatica questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a sciatica 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 sciatica questionnaire questions
Questions built from spine intake forms, written out so you can see the level of detail. Every practice words its own form differently.
- Which leg has the pain?Leg pain
- Where does the pain spread?Leg pain
- Is your back or your leg worse?Pain areas
- How much of your pain is in the leg?Pain areas
- How far can you walk?Walking
- Is your pain worse when walking?Walking
- Does coughing or sneezing make it worse?Pain triggers
- Does bending forward make it worse?Pain triggers
- Have you had an MRI of your back?Imaging tests
- Have you had a CT scan of your back?Imaging tests
- Have you had an epidural steroid injection?Past treatments
- Did physical therapy help your leg pain?Past treatments
These are examples to read, not a form to fill in.
Sciatica questionnaire: FAQ
What does a sciatica questionnaire ask?
The sample questions on this page are based on Main Line Health, Naples Comprehensive Health, and UCLA Health spine intake forms. This page groups them into six areas: leg pain, pain areas, walking, pain triggers, imaging tests, and past treatments.
Who fills in a sciatica questionnaire, and when?
A new patient with leg pain, as part of spine clinic paperwork. The Naples Comprehensive Health form asks patients to describe the symptoms they were referred for.
Does it rate leg pain separately from back pain?
Yes. The Naples Comprehensive Health form has one 0 to 10 scale for leg pain and another for back pain.
Does it ask how far the patient can walk?
Yes. The Main Line Health form has an open line for walking distance and asks when symptoms are better or worse.
Is there a sciatica questionnaire template?
The sample questions on this page show a typical set. The pain clinic decides which ones AI Doctor asks.
What happens after the form is completed?
The clinic's team looks over the answers before the visit. AI Doctor only collects them and doesn't name a cause or suggest an injection.
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.
