Diabetic Foot Care New Patient Questionnaire
What a diabetic foot care new patient questionnaire asks, with sample questions on diabetes, foot history, and footwear.
A diabetic foot care new patient questionnaire records diabetes details, past foot problems, related conditions, and shoes before a first podiatry visit. These questions are built from Stony Brook Medicine, Hunterdon Health, LSU Health Sciences Center, and foot and ankle clinics' forms, not a dedicated form.
Diabetic foot care new patient questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a diabetic foot care new patient 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 diabetic foot care new patient questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which type of diabetes do you have?Diabetes details
- When were you diagnosed with diabetes?Diabetes details
- Which doctor manages your diabetes?Diabetes care
- What were your last blood sugar and A1c?Diabetes care
- Have you had a foot ulcer in the past?Foot history
- Have you been hospitalized for a foot problem?Foot history
- Have you had foot or toe surgery?Foot surgery
- Have you had a toe or foot amputation?Foot surgery
- Has diabetes affected your nerves, eyes, kidneys, or skin?Related conditions
- Do you have circulation problems?Related conditions
- Do you wear diabetic shoes?Footwear
- Do you have trouble buying or wearing shoes?Footwear
These are examples to read, not a form to fill in.
Diabetic foot care new patient questionnaire: FAQ
What does a diabetic foot care new patient questionnaire ask?
The sample questions on this page are built from Stony Brook Medicine, Hunterdon Health, LSU Health Sciences Center, and foot and ankle clinics' forms. This page groups them into six areas: diabetes details, diabetes care, foot history, foot surgery, related conditions, and footwear.
Who fills in a diabetic foot care new patient questionnaire, and when?
The patient, before the first podiatry visit. One podiatry practice asks for its forms at least one day ahead, and asks patients with diabetes to bring their latest HbA1c lab.
Does it ask about diabetes complications?
Yes. The Stony Brook Medicine form asks when diabetes was diagnosed and whether the patient has neuropathy, retinopathy, kidney, or skin complications.
Does it ask about past foot surgery?
Yes. The LSU Health Sciences Center form counts foot and toe operations, including each type of amputation, along with foot-related hospital stays.
Is there a diabetic foot care new patient questionnaire template?
The sample questions on this page show a typical set. They combine items from general podiatry forms and one university diabetes foot program.
What happens after the form is completed?
The podiatry team reviews the diabetes and foot history before the visit. AI Doctor only collects it; it does not assess the feet or judge risk.
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.
